[Congressional Record (Bound Edition), Volume 152 (2006), Part 15]
[House]
[Pages 20451-20476]
[From the U.S. Government Publishing Office, www.gpo.gov]




        RYAN WHITE HIV/AIDS TREATMENT MODERNIZATION ACT OF 2006

  Mr. DEAL of Georgia. Mr. Speaker, I move to suspend the rules and 
pass the bill (H.R. 6143) to amend title XXVI of the Public Health 
Service Act to revise and extend the program for providing life-saving 
care for those with HIV/AIDS, as amended.
  The Clerk read as follows:

                               H.R. 6143

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Ryan White 
     HIV/AIDS Treatment Modernization Act of 2006''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.

              TITLE I--EMERGENCY RELIEF FOR ELIGIBLE AREAS

Sec. 101. Establishment of program; general eligibility for grants.
Sec. 102. Type and distribution of grants; formula grants.
Sec. 103. Type and distribution of grants; supplemental grants.
Sec. 104. Timeframe for obligation and expenditure of grant funds.
Sec. 105. Use of amounts.
Sec. 106. Additional amendments to part A.
Sec. 107. New program in part A; transitional grants for certain areas 
              ineligible under section 2601.
Sec. 108. Authorization of appropriations for part A.

                         TITLE II--CARE GRANTS

Sec. 201. General use of grants.
Sec. 202. AIDS Drug Assistance Program.
Sec. 203. Distribution of funds.
Sec. 204. Additional amendments to subpart I of part B.
Sec. 205. Supplemental grants on basis of demonstrated need.
Sec. 206. Emerging communities.
Sec. 207. Timeframe for obligation and expenditure of grant funds.
Sec. 208. Authorization of appropriations for subpart I of part B.
Sec. 209. Early diagnosis grant program.
Sec. 210. Certain partner notification programs; authorization of 
              appropriations.

                 TITLE III--EARLY INTERVENTION SERVICES

Sec. 301. Establishment of program; core medical services.
Sec. 302. Eligible entities; preferences; planning and development 
              grants.
Sec. 303. Authorization of appropriations.
Sec. 304. Confidentiality and informed consent.
Sec. 305. Provision of certain counseling services.
Sec. 306. General provisions.

             TITLE IV--WOMEN, INFANTS, CHILDREN, AND YOUTH

Sec. 401. Women, infants, children, and youth.
Sec. 402. GAO Report.

                      TITLE V--GENERAL PROVISIONS

Sec. 501. General provisions.

                  TITLE VI--DEMONSTRATION AND TRAINING

Sec. 601. Demonstration and training.
Sec. 602. AIDS education and training centers.
Sec. 603. Codification of minority AIDS initiative.

                  TITLE VII--MISCELLANEOUS PROVISIONS

Sec. 701. Hepatitis; use of funds.
Sec. 702. Certain references.

              TITLE I--EMERGENCY RELIEF FOR ELIGIBLE AREAS

     SEC. 101. ESTABLISHMENT OF PROGRAM; GENERAL ELIGIBILITY FOR 
                   GRANTS.

       (a) In General.--Section 2601 of the Public Health Service 
     Act (42 U.S.C. 300ff-11) is amended by striking subsections 
     (b) through (d) and inserting the following:
       ``(b) Continued Status as Eligible Area.--Notwithstanding 
     any other provision of this section, a metropolitan area that 
     is an eligible area for a fiscal year continues to be an 
     eligible area until the metropolitan area fails, for three 
     consecutive fiscal years--
       ``(1) to meet the requirements of subsection (a); and
       ``(2) to have a cumulative total of 3,000 or more living 
     cases of AIDS (reported to and confirmed by the Director of 
     the Centers for Disease Control and Prevention) as of 
     December 31 of the most recent calendar year for which such 
     data is available.
       ``(c) Boundaries.--For purposes of determining eligibility 
     under this part--
       ``(1) with respect to a metropolitan area that received 
     funding under this part in fiscal year 2006, the boundaries 
     of such metropolitan area shall be the boundaries that were 
     in effect for such area for fiscal year 1994; or
       ``(2) with respect to a metropolitan area that becomes 
     eligible to receive funding under this part in any fiscal 
     year after fiscal year 2006, the boundaries of such 
     metropolitan area shall be the boundaries that are in effect 
     for such area when such area initially receives funding under 
     this part.''.
       (b) Technical and Conforming Amendments.--Section 2601(a) 
     of the Public Health Service Act (42 U.S.C. 300ff-11(a)) is 
     amended--
       (1) by striking ``through (d)'' and inserting ``through 
     (c)''; and
       (2) by inserting ``and confirmed by'' after ``reported 
     to''.
       (c) Definition of Metropolitan Area.--Section 2607(2) of 
     the Public Health Service Act (42 U.S.C. 300ff-17(2)) is 
     amended--
       (1) by striking ``area referred'' and inserting ``area that 
     is referred''; and
       (2) by inserting before the period the following: ``, and 
     that has a population of 50,000 or more individuals''.

     SEC. 102. TYPE AND DISTRIBUTION OF GRANTS; FORMULA GRANTS.

       (a) Distribution Percentages.--Section 2603(a)(2) of the 
     Public Health Service Act (42 U.S.C. 300ff-13(a)(2)) is 
     amended--
       (1) in the first sentence--
       (A) by striking ``50 percent of the amount appropriated 
     under section 2677'' and inserting ``66\2/3\ percent of the 
     amount made available under section 2610(b) for carrying out 
     this subpart''; and
       (B) by striking ``paragraph (3)'' and inserting 
     ``paragraphs (3) and (4)''.
       (2) by striking the last sentence.
       (b) Distribution Based on Living Cases of HIV/AIDS.--
     Section 2603(a)(3) of the Public Health Service Act (42 
     U.S.C. 300ff-13(a)(3)) is amended--
       (1) in subparagraph (B), by striking ``estimated living 
     cases of acquired immune deficiency syndrome'' and inserting 
     ``living cases of HIV/AIDS (reported to and confirmed by the 
     Director of the Centers for Disease Control and 
     Prevention)''; and
       (2) by striking subparagraphs (C) through (E) and inserting 
     the following:
       ``(C) Living cases of hiv/aids.--
       ``(i) Requirement of names-based reporting.--Except as 
     provided in clause (ii), the number determined under this 
     subparagraph for an eligible area for a fiscal year for 
     purposes of subparagraph (B) is the number of living names-
     based cases of HIV/AIDS that, as of December 31 of the most 
     recent calendar year for which such data is available, have 
     been reported to and confirmed by the Director of the Centers 
     for Disease Control and Prevention.
       ``(ii) Transition period; exemption regarding non-aids 
     cases.--For each of the fiscal years 2007 through 2010, an 
     eligible area is, subject to clauses (iii) through (v), 
     exempt from the requirement under clause (i) that living 
     names-based non-AIDS cases of HIV be reported unless--

       ``(I) a system was in operation as of December 31, 2005, 
     that provides sufficiently accurate and reliable names-based 
     reporting of

[[Page 20452]]

     such cases throughout the State in which the area is located, 
     subject to clause (viii); or
       ``(II) no later than the beginning of fiscal year 2008, 
     2009, or 2010, the Secretary, in consultation with the chief 
     executive of the State in which the area is located, 
     determines that a system has become operational in the State 
     that provides sufficiently accurate and reliable names-based 
     reporting of such cases throughout the State.

       ``(iii) Requirements for exemption for fiscal year 2007.--
     For fiscal year 2007, an exemption under clause (ii) for an 
     eligible area applies only if, by October 1, 2006--

       ``(I)(aa) the State in which the area is located had 
     submitted to the Secretary a plan for making the transition 
     to sufficiently accurate and reliable names-based reporting 
     of living non-AIDS cases of HIV; or
       ``(bb) all statutory changes necessary to provide for 
     sufficiently accurate and reliable reporting of such cases 
     had been made; and
       ``(II) the State had agreed that, by April 1, 2008, the 
     State will begin accurate and reliable names-based reporting 
     of such cases, except that such agreement is not required to 
     provide that, as of such date, the system for such reporting 
     be fully sufficient with respect to accuracy and reliability 
     throughout the area.

       ``(iv) Requirement for exemption as of fiscal year 2008.--
     For each of the fiscal years 2008 through 2010, an exemption 
     under clause (ii) for an eligible area applies only if, as of 
     April 1, 2008, the State in which the area is located is 
     substantially in compliance with the agreement under clause 
     (iii)(II).
       ``(v) Progress toward names-based reporting.--For fiscal 
     year 2009 or 2010, the Secretary may terminate an exemption 
     under clause (ii) for an eligible area if the State in which 
     the area is located submitted a plan under clause 
     (iii)(I)(aa) and the Secretary determines that the State is 
     not substantially following the plan.
       ``(vi) Counting of cases in areas with exemptions.--

       ``(I) In general.--With respect to an eligible area that is 
     under a reporting system for living non-AIDS cases of HIV 
     that is not names-based (referred to in this subparagraph as 
     `code-based reporting'), the Secretary shall, for purposes of 
     this subparagraph, modify the number of such cases reported 
     for the eligible area in order to adjust for duplicative 
     reporting in and among systems that use code-based reporting.
       ``(II) Adjustment rate.--The adjustment rate under 
     subclause (I) for an eligible area shall be a reduction of 5 
     percent in the number of living non-AIDS cases of HIV 
     reported for the area.

       ``(vii) Multiple political jurisdictions.--With respect to 
     living non-AIDS cases of HIV, if an eligible area is not 
     entirely within one political jurisdiction and as a result is 
     subject to more than one reporting system for purposes of 
     this subparagraph:

       ``(I) Names-based reporting under clause (i) applies in a 
     jurisdictional portion of the area, or an exemption under 
     clause (ii) applies in such portion (subject to applicable 
     provisions of this subparagraph), according to whether names-
     based reporting or code-based reporting is used in such 
     portion.
       ``(II) If under subclause (I) both names-based reporting 
     and code-based reporting apply in the area, the number of 
     code-based cases shall be reduced under clause (vi).

       ``(viii) List of eligible areas meeting standard regarding 
     december 31, 2005.--

       ``(I) In general.--If an eligible area or portion thereof 
     is in a State specified in subclause (II), the eligible area 
     or portion shall be considered to meet the standard described 
     in clause (ii)(I). No other eligible area or portion thereof 
     may be considered to meet such standard.
       ``(II) Relevant states.--For purposes of subclause (I), the 
     States specified in this subclause are the following: Alaska, 
     Alabama, Arkansas, Arizona, Colorado, Florida, Indiana, Iowa, 
     Idaho, Kansas, Louisiana, Michigan, Minnesota, Missouri, 
     Mississippi, North Carolina, North Dakota, Nebraska, New 
     Jersey, New Mexico, New York, Nevada, Ohio, Oklahoma, South 
     Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, 
     Wisconsin, West Virginia, Wyoming, Guam, and the Virgin 
     Islands.

       ``(ix) Rules of construction regarding acceptance of 
     reports.--

       ``(I) Cases of aids.--With respect to an eligible area that 
     is subject to the requirement under clause (i) and is not in 
     compliance with the requirement for names-based reporting of 
     living non-AIDS cases of HIV, the Secretary shall, 
     notwithstanding such noncompliance, accept reports of living 
     cases of AIDS that are in accordance with such clause.
       ``(II) Applicability of exemption requirements.--The 
     provisions of clauses (ii) through (viii) may not be 
     construed as having any legal effect for fiscal year 2011 or 
     any subsequent fiscal year, and accordingly, the status of a 
     State for purposes of such clauses may not be considered 
     after fiscal year 2010.

       ``(x) Program for detecting inaccurate or fraudulent 
     counting.--The Secretary shall carry out a program to monitor 
     the reporting of names-based cases for purposes of this 
     subparagraph and to detect instances of inaccurate reporting, 
     including fraudulent reporting.''.
       (c) Code-Based Areas; Limitation on Increase in Grant.--
     Section 2603(a)(3) of the Public Health Service Act (42 
     U.S.C. 300ff-13(a)), as amended by subsection (b)(2) of this 
     section, is amended by adding at the end the following 
     subparagraph:
       ``(D) Code-based areas; limitation on increase in grant .--
       ``(i) In general.--For each of the fiscal years 2007 
     through 2010, if code-based reporting (within the meaning of 
     subparagraph (C)(vi)) applies in an eligible area or any 
     portion thereof as of the beginning of the fiscal year 
     involved, then notwithstanding any other provision of this 
     paragraph, the amount of the grant pursuant to this paragraph 
     for such area for such fiscal year may not--

       ``(I) for fiscal year 2007, exceed by more than 5 percent 
     the amount of the grant for the area that would have been 
     made pursuant to this paragraph and paragraph (4) for fiscal 
     year 2006 (as such paragraphs were in effect for such fiscal 
     year) if paragraph (2) (as so in effect) had been applied by 
     substituting `66\2/3\ percent' for `50 percent'; and
       ``(II) for each of the fiscal years 2008 and 2009, exceed 
     by more than 5 percent the amount of the grant pursuant to 
     this paragraph and paragraph (4) for the area for the 
     preceding fiscal year.

       ``(ii) Use of amounts involved.--For each of the fiscal 
     years 2007 through 2010, amounts available as a result of the 
     limitation under clause (i) shall be made available by the 
     Secretary as additional amounts for grants pursuant to 
     subsection (b) for the fiscal year involved, subject to 
     paragraph (4) and section 2610(d)(2).''.
       (d) Hold Harmless.--Section 2603(a) of the Public Health 
     Service Act (42 U.S.C. 300ff-13(a)) is amended--
       (1) in paragraph (3)(A)--
       (A) in clause (ii), by striking the period at the end and 
     inserting a semicolon; and
       (B) by inserting after and below clause (ii) the following:

     ``which product shall then, as applicable, be increased under 
     paragraph (4).''.
       (2) by amending paragraph (4) to read as follows:
       ``(4) Increases in grant.--
       ``(A) In general.--For each eligible area that received a 
     grant pursuant to this subsection for fiscal year 2006, the 
     Secretary shall, for each of the fiscal years 2007 through 
     2009, increase the amount of the grant made pursuant to 
     paragraph (3) for the area to ensure that the amount of the 
     grant for the fiscal year involved is not less than the 
     following amount, as applicable to such fiscal year:
       ``(i) For fiscal year 2007, an amount equal to 95 percent 
     of the amount of the grant that would have been made pursuant 
     to paragraph (3) and this paragraph for fiscal year 2006 (as 
     such paragraphs were in effect for such fiscal year) if 
     paragraph (2) (as so in effect) had been applied by 
     substituting `66\2/3\ percent' for `50 percent'.
       ``(ii) For each of the fiscal years 2008 and 2009, an 
     amount equal to 95 percent of the amount of the grant made 
     pursuant to paragraph (3) and this paragraph for the 
     preceding fiscal year.
       ``(B) Source of funds for increase.--
       ``(i) In general.--From the amounts available for carrying 
     out the single program referred to in section 2609(d)(2)(C) 
     for a fiscal year (relating to supplemental grants), the 
     Secretary shall make available such amounts as may be 
     necessary to comply with subparagraph (A), subject to section 
     2610(d)(2).
       ``(ii) Pro rata reduction.--If the amounts referred to in 
     clause (i) for a fiscal year are insufficient to fully comply 
     with subparagraph (A) for the year, the Secretary, in order 
     to provide the additional funds necessary for such 
     compliance, shall reduce on a pro rata basis the amount of 
     each grant pursuant to this subsection for the fiscal year, 
     other than grants for eligible areas for which increases 
     under subparagraph (A) apply. A reduction under the preceding 
     sentence may not be made in an amount that would result in 
     the eligible area involved becoming eligible for such an 
     increase.
       ``(C) Limitation.--This paragraph may not be construed as 
     having any applicability after fiscal year 2009.''.

     SEC. 103. TYPE AND DISTRIBUTION OF GRANTS; SUPPLEMENTAL 
                   GRANTS.

       Section 2603(b) of the Public Health Service Act (42 U.S.C. 
     300ff-13(b)) is amended--
       (1) in paragraph (1)--
       (A) in the matter preceding subparagraph (A), by striking 
     ``Not later than'' and all that follows through ``the 
     Secretary shall'' and inserting the following: ``Subject to 
     subsection (a)(4)(B)(i) and section 2610(d), the Secretary 
     shall'';
       (B) in subparagraph (B), by striking ``demonstrates the 
     severe need in such area'' and inserting ``demonstrates the 
     need in such area, on an objective and quantified basis,'';
       (C) by striking subparagraph (F) and inserting the 
     following:
       ``(F) demonstrates the inclusiveness of affected 
     communities and individuals with HIV/AIDS;'';
       (D) in subparagraph (G), by striking the period and 
     inserting ``; and''; and
       (E) by adding at the end the following:

[[Page 20453]]

       ``(H) demonstrates the ability of the applicant to expend 
     funds efficiently by not having had, for the most recent 
     grant year under subsection (a) for which data is available, 
     more than 2 percent of grant funds under such subsection 
     canceled or covered by any waivers under subsection 
     (c)(3).''; and
       (2) in paragraph (2)--
       (A) in subparagraph (A), by striking ``severe need'' and 
     inserting ``demonstrated need'';
       (B) by striking subparagraph (B) and inserting the 
     following:
       ``(B) Demonstrated need.--The factors considered by the 
     Secretary in determining whether an eligible area has a 
     demonstrated need for purposes of paragraph (1)(B) may 
     include any or all of the following:
       ``(i) The unmet need for such services, as determined under 
     section 2602(b)(4) or other community input process as 
     defined under section 2609(d)(1)(A).
       ``(ii) An increasing need for HIV/AIDS-related services, 
     including relative rates of increase in the number of cases 
     of HIV/AIDS.
       ``(iii) The relative rates of increase in the number of 
     cases of HIV/AIDS within new or emerging subpopulations.
       ``(iv) The current prevalence of HIV/AIDS.
       ``(v) Relevant factors related to the cost and complexity 
     of delivering health care to individuals with HIV/AIDS in the 
     eligible area.
       ``(vi) The impact of co-morbid factors, including co-
     occurring conditions, determined relevant by the Secretary.
       ``(vii) The prevalence of homelessness.
       ``(viii) The prevalence of individuals described under 
     section 2602(b)(2)(M).
       ``(ix) The relevant factors that limit access to health 
     care, including geographic variation, adequacy of health 
     insurance coverage, and language barriers.
       ``(x) The impact of a decline in the amount received 
     pursuant to subsection (a) on services available to all 
     individuals with HIV/AIDS identified and eligible under this 
     title.''; and
       (C) by striking subparagraphs (C) and (D) and inserting the 
     following:
       ``(C) Priority in making grants.--The Secretary shall 
     provide funds under this subsection to an eligible area to 
     address the decline in services related to the decline in the 
     amounts received pursuant to subsection (a) consistent with 
     the grant award for the eligible area for fiscal year 2006, 
     to the extent that the factor under subparagraph (B)(x) 
     (relating to a decline in funding) applies to the eligible 
     area.''.

     SEC. 104. TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF GRANT 
                   FUNDS.

       Section 2603 of the Public Health Service Act (42 U.S.C. 
     300ff-13) is amended--
       (1) by redesignating subsection (c) as subsection (d); and
       (2) by inserting after subsection (b) the following:
       ``(c) Timeframe for Obligation and Expenditure of Grant 
     Funds.--
       ``(1) Obligation by end of grant year.--Effective for 
     fiscal year 2007 and subsequent fiscal years, funds from a 
     grant award made pursuant to subsection (a) or (b) for a 
     fiscal year are available for obligation by the eligible area 
     involved through the end of the one-year period beginning on 
     the date in such fiscal year on which funds from the award 
     first become available to the area (referred to in this 
     subsection as the `grant year for the award'), except as 
     provided in paragraph (3)(A).
       ``(2) Supplemental grants; cancellation of unobligated 
     balance of grant award.--Effective for fiscal year 2007 and 
     subsequent fiscal years, if a grant award made pursuant to 
     subsection (b) for an eligible area for a fiscal year has an 
     unobligated balance as of the end of the grant year for the 
     award--
       ``(A) the Secretary shall cancel that unobligated balance 
     of the award, and shall require the eligible area to return 
     any amounts from such balance that have been disbursed to the 
     area; and
       ``(B) the funds involved shall be made available by the 
     Secretary as additional amounts for grants pursuant to 
     subsection (b) for the first fiscal year beginning after the 
     fiscal year in which the Secretary obtains the information 
     necessary for determining that the balance is required under 
     subparagraph (A) to be canceled, except that the availability 
     of the funds for such grants is subject to subsection (a)(4) 
     and section 2610(d)(2) as applied for such year.
       ``(3) Formula grants; cancellation of unobligated balance 
     of grant award; waiver permitting carryover.--
       ``(A) In general.--Effective for fiscal year 2007 and 
     subsequent fiscal years, if a grant award made pursuant to 
     subsection (a) for an eligible area for a fiscal year has an 
     unobligated balance as of the end of the grant year for the 
     award, the Secretary shall cancel that unobligated balance of 
     the award, and shall require the eligible area to return any 
     amounts from such balance that have been disbursed to the 
     area, unless--
       ``(i) before the end of the grant year, the chief elected 
     official of the area submits to the Secretary a written 
     application for a waiver of the cancellation, which 
     application includes a description of the purposes for which 
     the area intends to expend the funds involved; and
       ``(ii) the Secretary approves the waiver.
       ``(B) Expenditure by end of carryover year.--With respect 
     to a waiver under subparagraph (A) that is approved for a 
     balance that is unobligated as of the end of a grant year for 
     an award:
       ``(i) The unobligated funds are available for expenditure 
     by the eligible area involved for the one-year period 
     beginning upon the expiration of the grant year (referred to 
     in this subsection as the `carryover year').
       ``(ii) If the funds are not expended by the end of the 
     carryover year, the Secretary shall cancel that unexpended 
     balance of the award, and shall require the eligible area to 
     return any amounts from such balance that have been disbursed 
     to the area.
       ``(C) Use of cancelled balances.--In the case of any 
     balance of a grant award that is cancelled under subparagraph 
     (A) or (B)(ii), the grant funds involved shall be made 
     available by the Secretary as additional amounts for grants 
     pursuant to subsection (b) for the first fiscal year 
     beginning after the fiscal year in which the Secretary 
     obtains the information necessary for determining that the 
     balance is required under such subparagraph to be canceled, 
     except that the availability of the funds for such grants is 
     subject to subsection (a)(4) and section 2610(d)(2) as 
     applied for such year.
       ``(D) Corresponding reduction in future grant.--
       ``(i) In general.--In the case of an eligible area for 
     which a balance from a grant award under subsection (a) is 
     unobligated as of the end of the grant year for the award--

       ``(I) the Secretary shall reduce, by the same amount as 
     such unobligated balance, the amount of the grant under such 
     subsection for the first fiscal year beginning after the 
     fiscal year in which the Secretary obtains the information 
     necessary for determining that such balance was unobligated 
     as of the end of the grant year (which requirement for a 
     reduction applies without regard to whether a waiver under 
     subparagraph (A) has been approved with respect to such 
     balance); and
       ``(II) the grant funds involved in such reduction shall be 
     made available by the Secretary as additional funds for 
     grants pursuant to subsection (b) for such first fiscal year, 
     subject to subsection (a)(4) and section 2610(d)(2);

     except that this clause does not apply to the eligible area 
     if the amount of the unobligated balance was 2 percent or 
     less.
       ``(ii) Relation to increases in grant.--A reduction under 
     clause (i) for an eligible area for a fiscal year may not be 
     taken into account in applying subsection (a)(4) with respect 
     to the area for the subsequent fiscal year.''.

     SEC. 105. USE OF AMOUNTS.

       Section 2604 of the Public Health Service Act (42 U.S.C. 
     300ff-14) is amended to read as follows:

     ``SEC. 2604. USE OF AMOUNTS.

       ``(a) Requirements.--The Secretary may not make a grant 
     under section 2601(a) to the chief elected official of an 
     eligible area unless such political subdivision agrees that--
       ``(1) subject to paragraph (2), the allocation of funds and 
     services within the eligible area will be made in accordance 
     with the priorities established, pursuant to section 
     2602(b)(4)(C), by the HIV health services planning council 
     that serves such eligible area;
       ``(2) funds provided under section 2601 will be expended 
     only for--
       ``(A) core medical services described in subsection (c);
       ``(B) support services described in subsection (d); and
       ``(C) administrative expenses described in subsection (h); 
     and
       ``(3) the use of such funds will comply with the 
     requirements of this section.
       ``(b) Direct Financial Assistance to Appropriate 
     Entities.--
       ``(1) In general.--The chief elected official of an 
     eligible area shall use amounts from a grant under section 
     2601 to provide direct financial assistance to entities 
     described in paragraph (2) for the purpose of providing core 
     medical services and support services.
       ``(2) Appropriate entities.--Direct financial assistance 
     may be provided under paragraph (1) to public or nonprofit 
     private entities, or private for-profit entities if such 
     entities are the only available provider of quality HIV care 
     in the area.
       ``(c) Required Funding for Core Medical Services.--
       ``(1) In general.--With respect to a grant under section 
     2601 for an eligible area for a grant year, the chief elected 
     official of the area shall, of the portion of the grant 
     remaining after reserving amounts for purposes of paragraphs 
     (1) and (5)(B)(i) of subsection (h), use not less than 75 
     percent to provide core medical services that are needed in 
     the eligible area for individuals with HIV/AIDS who are 
     identified and eligible under this title (including services 
     regarding the co-occurring conditions of the individuals).
       ``(2) Waiver.--
       ``(A) In general.--The Secretary shall waive the 
     application of paragraph (1) with respect to a chief elected 
     official for a grant year if the Secretary determines that, 
     within the eligible area involved--
       ``(i) there are no waiting lists for AIDS Drug Assistance 
     Program services under section 2616; and

[[Page 20454]]

       ``(ii) core medical services are available to all 
     individuals with HIV/AIDS identified and eligible under this 
     title.
       ``(B) Notification of waiver status.--When informing the 
     chief elected official of an eligible area that a grant under 
     section 2601 is being made for the area for a grant year, the 
     Secretary shall inform the official whether a waiver under 
     subparagraph (A) is in effect for such year.
       ``(3) Core medical services.--For purposes of this 
     subsection, the term `core medical services', with respect to 
     an individual with HIV/AIDS (including the co-occurring 
     conditions of the individual), means the following services:
       ``(A) Outpatient and ambulatory health services.
       ``(B) AIDS Drug Assistance Program treatments in accordance 
     with section 2616.
       ``(C) AIDS pharmaceutical assistance.
       ``(D) Oral health care.
       ``(E) Early intervention services described in subsection 
     (e).
       ``(F) Health insurance premium and cost sharing assistance 
     for low-income individuals in accordance with section 2615.
       ``(G) Home health care.
       ``(H) Medical nutrition therapy.
       ``(I) Hospice services.
       ``(J) Home and community-based health services as defined 
     under section 2614(c).
       ``(K) Mental health services.
       ``(L) Substance abuse outpatient care.
       ``(M) Medical case management, including treatment 
     adherence services.
       ``(d) Support Services.--
       ``(1) In general.--For purposes of this section, the term 
     `support services' means services, subject to the approval of 
     the Secretary, that are needed for individuals with HIV/AIDS 
     to achieve their medical outcomes (such as respite care for 
     persons caring for individuals with HIV/AIDS, outreach 
     services, medical transportation, linguistic services, and 
     referrals for health care and support services).
       ``(2) Medical outcomes.--In this subsection, the term 
     `medical outcomes' means those outcomes affecting the HIV-
     related clinical status of an individual with HIV/AIDS.
       ``(e) Early Intervention Services.--
       ``(1) In general.--For purposes of this section, the term 
     `early intervention services' means HIV/AIDS early 
     intervention services described in section 2651(e), with 
     follow-up referral provided for the purpose of facilitating 
     the access of individuals receiving the services to HIV-
     related health services. The entities through which such 
     services may be provided under the grant include public 
     health departments, emergency rooms, substance abuse and 
     mental health treatment programs, detoxification centers, 
     detention facilities, clinics regarding sexually transmitted 
     diseases, homeless shelters, HIV/AIDS counseling and testing 
     sites, health care points of entry specified by eligible 
     areas, federally qualified health centers, and entities 
     described in section 2652(a) that constitute a point of 
     access to services by maintaining referral relationships.
       ``(2) Conditions.--With respect to an entity that proposes 
     to provide early intervention services under paragraph (1), 
     such paragraph shall apply only if the entity demonstrates to 
     the satisfaction of the chief elected official for the 
     eligible area involved that--
       ``(A) Federal, State, or local funds are otherwise 
     inadequate for the early intervention services the entity 
     proposes to provide; and
       ``(B) the entity will expend funds pursuant to such 
     paragraph to supplement and not supplant other funds 
     available to the entity for the provision of early 
     intervention services for the fiscal year involved.
       ``(f) Priority for Women, Infants, Children, and Youth.--
       ``(1) In general.--For the purpose of providing health and 
     support services to infants, children, youth, and women with 
     HIV/AIDS, including treatment measures to prevent the 
     perinatal transmission of HIV, the chief elected official of 
     an eligible area, in accordance with the established 
     priorities of the planning council, shall for each of such 
     populations in the eligible area use, from the grants made 
     for the area under section 2601(a) for a fiscal year, not 
     less than the percentage constituted by the ratio of the 
     population involved (infants, children, youth, or women in 
     such area) with HIV/AIDS to the general population in such 
     area of individuals with HIV/AIDS.
       ``(2) Waiver.--With respect to the population involved, the 
     Secretary may provide to the chief elected official of an 
     eligible area a waiver of the requirement of paragraph (1) if 
     such official demonstrates to the satisfaction of the 
     Secretary that the population is receiving HIV-related health 
     services through the State medicaid program under title XIX 
     of the Social Security Act, the State children's health 
     insurance program under title XXI of such Act, or other 
     Federal or State programs.
       ``(g) Requirement of Status as Medicaid Provider.--
       ``(1) Provision of service.--Subject to paragraph (2), the 
     Secretary may not make a grant under section 2601(a) for the 
     provision of services under this section in a State unless, 
     in the case of any such service that is available pursuant to 
     the State plan approved under title XIX of the Social 
     Security Act for the State--
       ``(A) the political subdivision involved will provide the 
     service directly, and the political subdivision has entered 
     into a participation agreement under the State plan and is 
     qualified to receive payments under such plan; or
       ``(B) the political subdivision will enter into an 
     agreement with a public or nonprofit private entity under 
     which the entity will provide the service, and the entity has 
     entered into such a participation agreement and is qualified 
     to receive such payments.
       ``(2) Waiver.--
       ``(A) In general.--In the case of an entity making an 
     agreement pursuant to paragraph (1)(B) regarding the 
     provision of services, the requirement established in such 
     paragraph shall be waived by the HIV health services planning 
     council for the eligible area if the entity does not, in 
     providing health care services, impose a charge or accept 
     reimbursement available from any third-party payor, including 
     reimbursement under any insurance policy or under any Federal 
     or State health benefits program.
       ``(B) Determination.--A determination by the HIV health 
     services planning council of whether an entity referred to in 
     subparagraph (A) meets the criteria for a waiver under such 
     subparagraph shall be made without regard to whether the 
     entity accepts voluntary donations for the purpose of 
     providing services to the public.
       ``(h) Administration.--
       ``(1) Limitation.--The chief elected official of an 
     eligible area shall not use in excess of 10 percent of 
     amounts received under a grant under this part for 
     administrative expenses.
       ``(2) Allocations by chief elected official.--In the case 
     of entities and subcontractors to which the chief elected 
     official of an eligible area allocates amounts received by 
     the official under a grant under this part, the official 
     shall ensure that, of the aggregate amount so allocated, the 
     total of the expenditures by such entities for administrative 
     expenses does not exceed 10 percent (without regard to 
     whether particular entities expend more than 10 percent for 
     such expenses).
       ``(3) Administrative activities.--For purposes of paragraph 
     (1), amounts may be used for administrative activities that 
     include--
       ``(A) routine grant administration and monitoring 
     activities, including the development of applications for 
     part A funds, the receipt and disbursal of program funds, the 
     development and establishment of reimbursement and accounting 
     systems, the development of a clinical quality management 
     program as described in paragraph (5), the preparation of 
     routine programmatic and financial reports, and compliance 
     with grant conditions and audit requirements; and
       ``(B) all activities associated with the grantee's contract 
     award procedures, including the activities carried out by the 
     HIV health services planning council as established under 
     section 2602(b), the development of requests for proposals, 
     contract proposal review activities, negotiation and awarding 
     of contracts, monitoring of contracts through telephone 
     consultation, written documentation or onsite visits, 
     reporting on contracts, and funding reallocation activities.
       ``(4) Subcontractor administrative activities.--For the 
     purposes of this subsection, subcontractor administrative 
     activities include--
       ``(A) usual and recognized overhead activities, including 
     established indirect rates for agencies;
       ``(B) management oversight of specific programs funded 
     under this title; and
       ``(C) other types of program support such as quality 
     assurance, quality control, and related activities.
       ``(5) Clinical quality management.--
       ``(A) Requirement.--The chief elected official of an 
     eligible area that receives a grant under this part shall 
     provide for the establishment of a clinical quality 
     management program to assess the extent to which HIV health 
     services provided to patients under the grant are consistent 
     with the most recent Public Health Service guidelines for the 
     treatment of HIV/AIDS and related opportunistic infection, 
     and as applicable, to develop strategies for ensuring that 
     such services are consistent with the guidelines for 
     improvement in the access to and quality of HIV health 
     services.
       ``(B) Use of funds.--
       ``(i) In general.--From amounts received under a grant 
     awarded under this subpart for a fiscal year, the chief 
     elected official of an eligible area may use for activities 
     associated with the clinical quality management program 
     required in subparagraph (A) not to exceed the lesser of--

       ``(I) 5 percent of amounts received under the grant; or
       ``(II) $3,000,000.

       ``(ii) Relation to limitation on administrative expenses.--
     The costs of a clinical quality management program under 
     subparagraph (A) may not be considered administrative 
     expenses for purposes of the limitation established in 
     paragraph (1).
       ``(i) Construction.--A chief elected official may not use 
     amounts received under a grant awarded under this part to 
     purchase or improve land, or to purchase, construct, or 
     permanently improve (other than minor remodeling) any 
     building or other facility, or to

[[Page 20455]]

     make cash payments to intended recipients of services.''.

     SEC. 106. ADDITIONAL AMENDMENTS TO PART A.

       (a) Reporting of Cases.--Section 2601(a) of the Public 
     Health Service Act (42 U.S.C. 300ff-11(a)) is amended by 
     striking ``for the most recent period'' and inserting 
     ``during the most recent period''.
       (b) Planning Council Representation.--Section 2602(b)(2)(G) 
     of the Public Health Service Act (42 U.S.C. 300ff-
     12(b)(2)(G)) is amended by inserting ``, members of a 
     Federally recognized Indian tribe as represented in the 
     population, individuals co-infected with hepatitis B or C'' 
     after ``disease''.
       (c) Application for Grant.--
       (1) Payer of last resort.--Section 2605(a)(6)(A) of the 
     Public Health Service Act (42 U.S.C. 300ff-15(a)(6)(A)) is 
     amended by inserting ``(except for a program administered by 
     or providing the services of the Indian Health Service)'' 
     before the semicolon.
       (2) Audits.--Section 2605(a) of the Public Health Service 
     Act (42 U.S.C. 300ff-15(a)) is amended--
       (A) in paragraph (8), by striking ``and'' at the end;
       (B) in paragraph (9), by striking the period and inserting 
     ``; and''; and
       (C) by adding at the end the following:
       ``(10) that the chief elected official will submit to the 
     lead State agency under section 2617(b)(4), audits, 
     consistent with Office of Management and Budget circular 
     A133, regarding funds expended in accordance with this part 
     every 2 years and shall include necessary client-based data 
     to compile unmet need calculations and Statewide coordinated 
     statements of need process.''.
       (3) Coordination.--Section 2605(b) of the Public Health 
     Service Act (42 U.S.C. 300ff-15(b)) is amended--
       (A) in paragraph (3), by striking ``and'' at the end;
       (B) in paragraph (4), by striking the period and inserting 
     a semicolon; and
       (C) by adding at the end the following:
       ``(5) the manner in which the expected expenditures are 
     related to the planning process for States that receive 
     funding under part B (including the planning process 
     described in section 2617(b)); and
       ``(6) the expected expenditures and how those expenditures 
     will improve overall client outcomes, as described under the 
     State plan under section 2617(b), and through additional 
     outcomes measures as identified by the HIV health services 
     planning council under section 2602(b).''.

     SEC. 107. NEW PROGRAM IN PART A; TRANSITIONAL GRANTS FOR 
                   CERTAIN AREAS INELIGIBLE UNDER SECTION 2601.

       (a) In General.--Part A of title XXVI of the Public Health 
     Service Act (42 U.S.C. 300ff-11) is amended--
       (1) by inserting after the part heading the following:

              ``Subpart I--General Grant Provisions''; and

       (2) by adding at the end the following:

                   ``Subpart II--Transitional Grants

     ``SEC. 2609. ESTABLISHMENT OF PROGRAM.

       ``(a) In General.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, shall make grants for the purpose of 
     providing services described in section 2604 in transitional 
     areas, subject to the same provisions regarding the 
     allocation of grant funds as apply under subsection (c) of 
     such section.
       ``(b) Transitional Areas.--For purposes of this section, 
     the term `transitional area' means, subject to subsection 
     (c), a metropolitan area for which there has been reported to 
     and confirmed by the Director of the Centers for Disease 
     Control and Prevention a cumulative total of at least 1,000, 
     but fewer than 2,000, cases of AIDS during the most recent 
     period of 5 calendar years for which such data are available.
       ``(c) Certain Eligibility Rules.--
       ``(1) Fiscal year 2007.--With respect to grants under 
     subsection (a) for fiscal year 2007, a metropolitan area that 
     received funding under subpart I for fiscal year 2006 but 
     does not for fiscal year 2007 qualify under such subpart as 
     an eligible area and does not qualify under subsection (b) as 
     a transitional area shall, notwithstanding subsection (b), be 
     considered a transitional area.
       ``(2) Continued status as transitional area.--
       ``(A) In general.--Notwithstanding subsection (b), a 
     metropolitan area that is a transitional area for a fiscal 
     year continues, except as provided in subparagraph (B), to be 
     a transitional area until the metropolitan area fails, for 
     three consecutive fiscal years--
       ``(i) to qualify under such subsection as a transitional 
     area; and
       ``(ii) to have a cumulative total of 1,500 or more living 
     cases of AIDS (reported to and confirmed by the Director of 
     the Centers for Disease Control and Prevention) as of 
     December 31 of the most recent calendar year for which such 
     data is available.
       ``(B) Exception regarding status as eligible area.--
     Subparagraph (A) does not apply for a fiscal year if the 
     metropolitan area involved qualifies under subpart I as an 
     eligible area.
       ``(d) Application of Certain Provisions of Subpart I.--
       ``(1) Administration; planning council.--
       ``(A) In general.--The provisions of section 2602 apply 
     with respect to a grant under subsection (a) for a 
     transitional area to the same extent and in the same manner 
     as such provisions apply with respect to a grant under 
     subpart I for an eligible area, except that, subject to 
     subparagraph (B), the chief elected official of the 
     transitional area may elect not to comply with the provisions 
     of section 2602(b) if the official provides documentation to 
     the Secretary that details the process used to obtain 
     community input (particularly from those with HIV) in the 
     transitional area for formulating the overall plan for 
     priority setting and allocating funds from the grant under 
     subsection (a).
       ``(B) Exception.--For each of the fiscal years 2007 through 
     2009, the exception described in subparagraph (A) does not 
     apply if the transitional area involved received funding 
     under subpart I for fiscal year 2006.
       ``(2) Type and distribution of grants; timeframe for 
     obligation and expenditure of grant funds.--
       ``(A) Formula grants; supplemental grants.--The provisions 
     of section 2603 apply with respect to grants under subsection 
     (a) to the same extent and in the same manner as such 
     provisions apply with respect to grants under subpart I, 
     subject to subparagraphs (B) and (C).
       ``(B) Formula grants; increase in grant.--For purposes of 
     subparagraph (A), section 2603(a)(4) does not apply.
       ``(C) Supplemental grants; single program with subpart i 
     program.--With respect to section 2603(b) as applied for 
     purposes of subparagraph (A):
       ``(i) The Secretary shall combine amounts available 
     pursuant to such subparagraph with amounts available for 
     carrying out section 2603(b) and shall administer the two 
     programs as a single program.
       ``(ii) In the single program, the Secretary has discretion 
     in allocating amounts between eligible areas under subpart I 
     and transitional areas under this section, subject to the 
     eligibility criteria that apply under such section, and 
     subject to section 2603(b)(2)(C) (relating to priority in 
     making grants).
       ``(iii) Pursuant to section 2603(b)(1), amounts for the 
     single program are subject to use under sections 2603(a)(4) 
     and 2610(d)(1).
       ``(3) Application; technical assistance; definitions.--The 
     provisions of sections 2605, 2606, and 2607 apply with 
     respect to grants under subsection (a) to the same extent and 
     in the same manner as such provisions apply with respect to 
     grants under subpart I.''.
       (b) Conforming Amendments.--Subpart I of part A of title 
     XXVI of the Public Health Service Act, as designated by 
     subsection (a)(1) of this section, is amended by striking 
     ``this part'' each place such term appears and inserting 
     ``this subpart''.

     SEC. 108. AUTHORIZATION OF APPROPRIATIONS FOR PART A.

       Part A of title XXVI of the Public Health Service Act, as 
     amended by section 106(a), is amended by adding at the end 
     the following:

                   ``Subpart III--General Provisions

     ``SEC. 2610. AUTHORIZATION OF APPROPRIATIONS.

       ``(a) In General.--For the purpose of carrying out this 
     part, there are authorized to be appropriated $604,000,000 
     for fiscal year 2007, $626,300,000 for fiscal year 2008, 
     $649,500,000 for fiscal year 2009, $673,600,000 for fiscal 
     year 2010, and $698,500,000 for fiscal year 2011. Amounts 
     appropriated under the preceding sentence for a fiscal year 
     are available for obligation by the Secretary until the end 
     of the second succeeding fiscal year.
       ``(b) Reservation of Amounts.--
       ``(1) Fiscal year 2007.--Of the amount appropriated under 
     subsection (a) for fiscal year 2007, the Secretary shall 
     reserve--
       ``(A) $458,310,000 for grants under subpart I; and
       ``(B) $145,690,000 for grants under section 2609.
       ``(2) Subsequent fiscal years.--Of the amount appropriated 
     under subsection (a) for fiscal year 2008 and each subsequent 
     fiscal year--
       ``(A) the Secretary shall reserve an amount for grants 
     under subpart I; and
       ``(B) the Secretary shall reserve an amount for grants 
     under section 2609.
       ``(c) Transfer of Certain Amounts; Change in Status as 
     Eligible Area or Transitional Area.--Notwithstanding 
     subsection (b):
       ``(1) If a metropolitan area is an eligible area under 
     subpart I for a fiscal year, but for a subsequent fiscal year 
     ceases to be an eligible area by reason of section 2601(b)--
       ``(A)(i) the amount reserved under paragraph (1)(A) or 
     (2)(A) of subsection (b) of this section for the first such 
     subsequent year of not being an eligible area is deemed to be 
     reduced by an amount equal to the amount of the grant made 
     pursuant to section 2603(a) for the metropolitan area for the 
     preceding fiscal year; and
       ``(ii)(I) if the metropolitan area qualifies for such first 
     subsequent fiscal year as a transitional area under 2609, the 
     amount reserved under paragraph (1)(B) or (2)(B) of 
     subsection (b) for such fiscal year is deemed to be increased 
     by an amount equal to the amount of the reduction under 
     subparagraph (A) for such year; or
       ``(II) if the metropolitan area does not qualify for such 
     first subsequent fiscal year

[[Page 20456]]

     as a transitional area under 2609, an amount equal to the 
     amount of such reduction is, notwithstanding subsection (a), 
     transferred and made available for grants pursuant to section 
     2618(a)(1), in addition to amounts available for such grants 
     under section 2623; and
       ``(B) if a transfer under subparagraph (A)(ii)(II) is made 
     with respect to the metropolitan area for such first 
     subsequent fiscal year, then--
       ``(i) the amount reserved under paragraph (1)(A) or (2)(A) 
     of subsection (b) of this section for such year is deemed to 
     be reduced by an additional $500,000; and
       ``(ii) an amount equal to the amount of such additional 
     reduction is, notwithstanding subsection (a), transferred and 
     made available for grants pursuant to section 2618(a)(1), in 
     addition to amounts available for such grants under section 
     2623.
       ``(2) If a metropolitan area is a transitional area under 
     section 2609 for a fiscal year, but for a subsequent fiscal 
     year ceases to be a transitional area by reason of section 
     2609(c)(2) (and does not qualify for such subsequent fiscal 
     year as an eligible area under subpart I)--
       ``(A) the amount reserved under subsection (b)(2)(B) of 
     this section for the first such subsequent fiscal year of not 
     being a transitional area is deemed to be reduced by an 
     amount equal to the total of--
       ``(i) the amount of the grant that, pursuant to section 
     2603(a), was made under section 2609(d)(2)(A) for the 
     metropolitan area for the preceding fiscal year; and
       ``(ii) $500,000; and
       ``(B) an amount equal to the amount of the reduction under 
     subparagraph (A) for such year is, notwithstanding subsection 
     (a), transferred and made available for grants pursuant to 
     section 2618(a)(1), in addition to amounts available for such 
     grants under section 2623.
       ``(3) If a metropolitan area is a transitional area under 
     section 2609 for a fiscal year, but for a subsequent fiscal 
     year qualifies as an eligible area under subpart I--
       ``(A) the amount reserved under subsection (b)(2)(B) of 
     this section for the first such subsequent fiscal year of 
     becoming an eligible area is deemed to be reduced by an 
     amount equal to the amount of the grant that, pursuant to 
     section 2603(a), was made under section 2609(d)(2)(A) for the 
     metropolitan area for the preceding fiscal year; and
       ``(B) the amount reserved under subsection (b)(2)(A) for 
     such fiscal year is deemed to be increased by an amount equal 
     to the amount of the reduction under subparagraph (A) for 
     such year.
       ``(d) Certain Transfers; Allocations Between Programs Under 
     Subpart I.--With respect to paragraphs (1)(B)(i) and 
     (2)(A)(ii) of subsection (c), the Secretary shall administer 
     any reductions under such paragraphs for a fiscal year in 
     accordance with the following:
       ``(1) The reductions shall be made from amounts available 
     for the single program referred to in section 2609(d)(2)(C) 
     (relating to supplemental grants).
       ``(2) The reductions shall be made before the amounts 
     referred to in paragraph (1) are used for purposes of section 
     2603(a)(4).
       ``(3) If the amounts referred to in paragraph (1) are not 
     sufficient for making all the reductions, the reductions 
     shall be reduced until the total amount of the reductions 
     equals the total of the amounts referred to in such 
     paragraph.
       ``(e) Rules of Construction Regarding First Subsequent 
     Fiscal Year.--Paragraphs (1) and (2) of subsection (c) apply 
     with respect to each series of fiscal years during which a 
     metropolitan area is an eligible area under subpart I or a 
     transitional area under section 2609 for a fiscal year and 
     then for a subsequent fiscal year ceases to be such an area 
     by reason of section 2601(b) or 2609(c)(2), respectively, 
     rather than applying to a single such series. Paragraph (3) 
     of subsection (c) applies with respect to each series of 
     fiscal years during which a metropolitan area is a 
     transitional area under section 2609 for a fiscal year and 
     then for a subsequent fiscal year becomes an eligible area 
     under subpart I, rather than applying to a single such 
     series.''.

                         TITLE II--CARE GRANTS

     SEC. 201. GENERAL USE OF GRANTS.

       (a) In General.--Section 2612 of the Public Health Service 
     Act (42 U.S.C. 300ff-22) is amended to read as follows:

     ``SEC. 2612. GENERAL USE OF GRANTS.

       ``(a) In General.--A State may use amounts provided under 
     grants made under section 2611 for--
       ``(1) core medical services described in subsection (b);
       ``(2) support services described in subsection (c); and
       ``(3) administrative expenses described in section 
     2618(b)(3).
       ``(b) Required Funding for Core Medical Services.--
       ``(1) In general.--With respect to a grant under section 
     2611 for a State for a grant year, the State shall, of the 
     portion of the grant remaining after reserving amounts for 
     purposes of subparagraphs (A) and (E)(ii)(I) of section 
     2618(b)(3), use not less than 75 percent to provide core 
     medical services that are needed in the State for individuals 
     with HIV/AIDS who are identified and eligible under this 
     title (including services regarding the co-occurring 
     conditions of the individuals).
       ``(2) Waiver.--
       ``(A) In general.--The Secretary shall waive the 
     application of paragraph (1) with respect to a State for a 
     grant year if the Secretary determines that, within the 
     State--
       ``(i) there are no waiting lists for AIDS Drug Assistance 
     Program services under section 2616; and
       ``(ii) core medical services are available to all 
     individuals with HIV/AIDS identified and eligible under this 
     title.
       ``(B) Notification of waiver status.--When informing a 
     State that a grant under section 2611 is being made to the 
     State for a fiscal year, the Secretary shall inform the State 
     whether a waiver under subparagraph (A) is in effect for the 
     fiscal year.
       ``(3) Core medical services.--For purposes of this 
     subsection, the term `core medical services', with respect to 
     an individual infected with HIV/AIDS (including the co-
     occurring conditions of the individual) means the following 
     services:
       ``(A) Outpatient and ambulatory health services.
       ``(B) AIDS Drug Assistance Program treatments in accordance 
     with section 2616.
       ``(C) AIDS pharmaceutical assistance.
       ``(D) Oral health care.
       ``(E) Early intervention services described in subsection 
     (d).
       ``(F) Health insurance premium and cost sharing assistance 
     for low-income individuals in accordance with section 2615.
       ``(G) Home health care.
       ``(H) Medical nutrition therapy.
       ``(I) Hospice services.
       ``(J) Home and community-based health services as defined 
     under section 2614(c).
       ``(K) Mental health services.
       ``(L) Substance abuse outpatient care.
       ``(M) Medical case management, including treatment 
     adherence services.
       ``(c) Support Services.--
       ``(1) In general.--For purposes of this subsection, the 
     term `support services' means services, subject to the 
     approval of the Secretary, that are needed for individuals 
     with HIV/AIDS to achieve their medical outcomes (such as 
     respite care for persons caring for individuals with HIV/
     AIDS, outreach services, medical transportation, linguistic 
     services, and referrals for health care and support 
     services).
       ``(2) Definition of medical outcomes.--In this subsection, 
     the term `medical outcomes' means those outcomes affecting 
     the HIV-related clinical status of an individual with HIV/
     AIDS.
       ``(d) Early Intervention Services.--
       ``(1) In general.--For purposes of this section, the term 
     `early intervention services' means HIV/AIDS early 
     intervention services described in section 2651(e), with 
     follow-up referral provided for the purpose of facilitating 
     the access of individuals receiving the services to HIV-
     related health services. The entities through which such 
     services may be provided under the grant include public 
     health departments, emergency rooms, substance abuse and 
     mental health treatment programs, detoxification centers, 
     detention facilities, clinics regarding sexually transmitted 
     diseases, homeless shelters, HIV/AIDS counseling and testing 
     sites, health care points of entry specified by States, 
     federally qualified health centers, and entities described in 
     section 2652(a) that constitute a point of access to services 
     by maintaining referral relationships.
       ``(2) Conditions.--With respect to an entity that proposes 
     to provide early intervention services under paragraph (1), 
     such paragraph shall apply only if the entity demonstrates to 
     the satisfaction of the chief elected official for the State 
     involved that--
       ``(A) Federal, State, or local funds are otherwise 
     inadequate for the early intervention services the entity 
     proposes to provide; and
       ``(B) the entity will expend funds pursuant to such 
     subparagraph to supplement and not supplant other funds 
     available to the entity for the provision of early 
     intervention services for the fiscal year involved.
       ``(e) Priority for Women, Infants, Children, and Youth.--
       ``(1) In general.--For the purpose of providing health and 
     support services to infants, children, youth, and women with 
     HIV/AIDS, including treatment measures to prevent the 
     perinatal transmission of HIV, a State shall for each of such 
     populations in the eligible area use, from the grants made 
     for the area under section 2601(a) for a fiscal year, not 
     less than the percentage constituted by the ratio of the 
     population involved (infants, children, youth, or women in 
     such area) with HIV/AIDS to the general population in such 
     area of individuals with HIV/AIDS.
       ``(2) Waiver.--With respect to the population involved, the 
     Secretary may provide to a State a waiver of the requirement 
     of paragraph (1) if such State demonstrates to the 
     satisfaction of the Secretary that the population is 
     receiving HIV-related health services through the State 
     medicaid program under title XIX of the Social Security Act, 
     the State children's health insurance program under title XXI 
     of such Act, or other Federal or State programs.
       ``(f) Construction.--A State may not use amounts received 
     under a grant awarded under section 2611 to purchase or 
     improve

[[Page 20457]]

     land, or to purchase, construct, or permanently improve 
     (other than minor remodeling) any building or other facility, 
     or to make cash payments to intended recipients of 
     services.''.
       (b) HIV Care Consortia.--Section 2613 of the Public Health 
     Service Act (42 U.S.C. 300ff-23) is amended--
       (1) in subsection (a), in the matter preceding paragraph 
     (1)--
       (A) by striking ``may use'' and inserting ``may, subject to 
     subsection (f), use''; and
       (B) by striking ``section 2612(a)(1)'' and inserting 
     ``section 2612(a)''; and
       (2) by adding at the end the following subsection:
       ``(f) Allocation of Funds; Treatment as Support Services.--
     For purposes of the requirement of section 2612(b)(1), 
     expenditures of grants under section 2611 for or through 
     consortia under this section are deemed to be support 
     services, not core medical services. The preceding sentence 
     may not be construed as having any legal effect on the 
     provisions of subsection (a) that relate to authorized 
     expenditures of the grant.''.
       (c) Technical Amendments.--Part B of title XXVI of the 
     Public Health Service Act (42 U.S.C. 300ff-21 et seq.) is 
     amended--
       (1) in section 2611--
       (A) in subsection (a), by striking the subsection 
     designation and heading; and
       (B) by striking subsection (b);
       (2) in section 2614--
       (A) in subsection (a), in the matter preceding paragraph 
     (1), by striking ``section 2612(a)(2)'' and inserting 
     ``section 2612(b)(3)(J)''; and
       (B) in subsection (c)(2)(B), by striking ``homemaker or'';
       (3) in section 2615(a) by striking ``section 2612(a)(3)'' 
     and inserting ``section 2612(b)(3)(F)''; and
       (4) in section 2616(a) by striking ``section 2612(a)(5)'' 
     and inserting ``section 2612(b)(3)(B)''.

     SEC. 202. AIDS DRUG ASSISTANCE PROGRAM.

       (a) Requirement of Minimum Drug List.--Section 2616 of the 
     Public Health Service Act (42 U.S.C. 300ff-26) is amended--
       (1) in subsection (c), by striking paragraph (1) and 
     inserting the following:
       ``(1) ensure that the therapeutics included on the list of 
     classes of core antiretroviral therapeutics established by 
     the Secretary under subsection (e) are, at a minimum, the 
     treatments provided by the State pursuant to this section;'';
       (2) by redesignating subsection (e) as subsection (f); and
       (3) by inserting after subsection (d) the following:
       ``(e) List of Classes of Core Antiretroviral 
     Therapeutics.--For purposes of subsection (c)(1), the 
     Secretary shall develop and maintain a list of classes of 
     core antiretroviral therapeutics, which list shall be based 
     on the therapeutics included in the guidelines of the 
     Secretary known as the Clinical Practice Guidelines for Use 
     of HIV/AIDS Drugs, relating to drugs needed to manage 
     symptoms associated with HIV. The preceding sentence does not 
     affect the authority of the Secretary to modify such 
     Guidelines.''.
       (b) Drug Rebate Program.--Section 2616 of the Public Health 
     Service Act, as amended by subsection (a)(2) of this section, 
     is amended by adding at the end the following:
       ``(g) Drug Rebate Program.--A State shall ensure that any 
     drug rebates received on drugs purchased from funds provided 
     pursuant to this section are applied to activities supported 
     under this subpart, with priority given to activities 
     described under this section.''.

     SEC. 203. DISTRIBUTION OF FUNDS.

       (a) Distribution Based on Living Cases of HIV/AIDS.--
       (1) State distribution factor.--Section 2618(a)(2) of the 
     Public Health Service Act (42 U.S.C. 300ff-28(a)(2)) is 
     amended--
       (A) in subparagraph (B), by striking ``estimated number of 
     living cases of acquired immune deficiency syndrome in the 
     eligible area involved'' and inserting ``number of living 
     cases of HIV/AIDS in the State involved''; and
       (B) by amending subparagraph (D) to read as follows:
       ``(D) Living cases of hiv/aids.--
       ``(i) Requirement of names-based reporting.--Except as 
     provided in clause (ii), the number determined under this 
     subparagraph for a State for a fiscal year for purposes of 
     subparagraph (B) is the number of living names-based cases of 
     HIV/AIDS in the State that, as of December 31 of the most 
     recent calendar year for which such data is available, have 
     been reported to and confirmed by the Director of the Centers 
     for Disease Control and Prevention.
       ``(ii) Transition period; exemption regarding non-aids 
     cases.--For each of the fiscal years 2007 through 2010, a 
     State is, subject to clauses (iii) through (v), exempt from 
     the requirement under clause (i) that living non-AIDS names-
     based cases of HIV be reported unless--

       ``(I) a system was in operation as of December 31, 2005, 
     that provides sufficiently accurate and reliable names-based 
     reporting of such cases throughout the State, subject to 
     clause (vii); or
       ``(II) no later than the beginning of fiscal year 2008, 
     2009, or 2010, the Secretary, after consultation with the 
     chief executive of the State, determines that a system has 
     become operational in the State that provides sufficiently 
     accurate and reliable names-based reporting of such cases 
     throughout the State.

       ``(iii) Requirements for exemption for fiscal year 2007.--
     For fiscal year 2007, an exemption under clause (ii) for a 
     State applies only if, by October 1, 2006--

       ``(I)(aa) the State had submitted to the Secretary a plan 
     for making the transition to sufficiently accurate and 
     reliable names-based reporting of living non-AIDS cases of 
     HIV; or
       ``(bb) all statutory changes necessary to provide for 
     sufficiently accurate and reliable reporting of such cases 
     had been made; and
       ``(II) the State had agreed that, by April 1, 2008, the 
     State will begin accurate and reliable names-based reporting 
     of such cases, except that such agreement is not required to 
     provide that, as of such date, the system for such reporting 
     be fully sufficient with respect to accuracy and reliability 
     throughout the area.

       ``(iv) Requirement for exemption as of fiscal year 2008.--
     For each of the fiscal years 2008 through 2010, an exemption 
     under clause (ii) for a State applies only if, as of April 1, 
     2008, the State is substantially in compliance with the 
     agreement under clause (iii)(II).
       ``(v) Progress toward names-based reporting.--For fiscal 
     year 2009 or 2010, the Secretary may terminate an exemption 
     under clause (ii) for a State if the State submitted a plan 
     under clause (iii)(I)(aa) and the Secretary determines that 
     the State is not substantially following the plan.
       ``(vi) Counting of cases in areas with exemptions.--

       ``(I) In general.--With respect to a State that is under a 
     reporting system for living non-AIDS cases of HIV that is not 
     names-based (referred to in this subparagraph as `code-based 
     reporting'), the Secretary shall, for purposes of this 
     subparagraph, modify the number of such cases reported for 
     the State in order to adjust for duplicative reporting in and 
     among systems that use code-based reporting.
       ``(II) Adjustment rate.--The adjustment rate under 
     subclause (I) for a State shall be a reduction of 5 percent 
     in the number of living non-AIDS cases of HIV reported for 
     the State.

       ``(vii) List of states meeting standard regarding december 
     31, 2005.--

       ``(I) In general.--If a State is specified in subclause 
     (II), the State shall be considered to meet the standard 
     described in clause (ii)(I). No other State may be considered 
     to meet such standard.
       ``(II) Relevant states.--For purposes of subclause (I), the 
     States specified in this subclause are the following: Alaska, 
     Alabama, Arkansas, Arizona, Colorado, Florida, Indiana, Iowa, 
     Idaho, Kansas, Louisiana, Michigan, Minnesota, Missouri, 
     Mississippi, North Carolina, North Dakota, Nebraska, New 
     Jersey, New Mexico, New York, Nevada, Ohio, Oklahoma, South 
     Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, 
     Wisconsin, West Virginia, Wyoming, Guam, and the Virgin 
     Islands.

       ``(viii) Rules of construction regarding acceptance of 
     reports.--

       ``(I) Cases of aids.--With respect to a State that is 
     subject to the requirement under clause (i) and is not in 
     compliance with the requirement for names-based reporting of 
     living non-AIDS cases of HIV, the Secretary shall, 
     notwithstanding such noncompliance, accept reports of living 
     cases of AIDS that are in accordance with such clause.
       ``(II) Applicability of exemption requirements.--The 
     provisions of clauses (ii) through (vii) may not be construed 
     as having any legal effect for fiscal year 2011 or any 
     subsequent fiscal year, and accordingly, the status of a 
     State for purposes of such clauses may not be considered 
     after fiscal year 2010.

       ``(ix) Program for detecting inaccurate or fraudulent 
     counting.--The Secretary shall carry out a program to monitor 
     the reporting of names-based cases for purposes of this 
     subparagraph and to detect instances of inaccurate reporting, 
     including fraudulent reporting.''.
       (2) Non-ema distribution factor.--Section 2618(a)(2)(C) of 
     the Public Health Service Act (42 U.S.C. 300ff-28(a)(2)(C)) 
     is amended--
       (A) in clause (i), by striking ``estimated number of living 
     cases of acquired immune deficiency syndrome'' each place 
     such term appears and inserting ``number of living cases of 
     HIV/AIDS''; and
       (B) in clause (ii), by amending such clause to read as 
     follows:
       ``(ii) a number equal to the sum of--

       ``(I) the total number of living cases of HIV/AIDS that are 
     within areas in such State that are eligible areas under 
     subpart I of part A for the fiscal year involved, which 
     individual number for an area is the number that applies 
     under section 2601 for the area for such fiscal year; and
       ``(II) the total number of such cases that are within areas 
     in such State that are transitional areas under section 2609 
     for such fiscal year, which individual number for an area is 
     the number that applies under such section for the fiscal 
     year.''.

[[Page 20458]]

       (b) Formula Amendments Generally.--Section 2618(a)(2) of 
     the Public Health Service Act (42 U.S.C. 300ff-28(a)(2)) is 
     amended--
       (1) in subparagraph (A)--
       (A) by striking ``The amount referred to'' in the matter 
     preceding clause (i) and all that follows through the end of 
     clause (i) and inserting the following: ``For purposes of 
     paragraph (1), the amount referred to in this paragraph for a 
     State (including a territory) for a fiscal year is, subject 
     to subparagraphs (E) and (F)--
       ``(i) an amount equal to the amount made available under 
     section 2623 for the fiscal year involved for grants pursuant 
     to paragraph (1), subject to subparagraph (G); and''; and
       (B) in clause (ii)--
       (i) in subclause (I)--

       (I) by striking ``.80'' and inserting ``0.75''; and
       (II) by striking ``and'' at the end;

       (ii) in subclause (II)--

       (I) by inserting ``non-EMA'' after ``respective''; and
       (II) by striking the period and inserting ``; and''; and

       (iii) by adding at the end the following:

       ``(III) if the State does not for such fiscal year contain 
     any area that is an eligible area under subpart I of part A 
     or any area that is a transitional area under section 2609 
     (referred to in this subclause as a `no-EMA State'), the 
     product of 0.05 and the ratio of the number of cases that 
     applies for the State under subparagraph (D) to the sum of 
     the respective numbers of cases that so apply for all no-EMA 
     States.'';

       (2) by striking subparagraphs (E) through (H);
       (3) by inserting after subparagraph (D) the following 
     subparagraphs:
       ``(E) Code-based states; limitation on increase in grant.--
       ``(i) In general.--For each of the fiscal years 2007 
     through 2010, if code-based reporting (within the meaning of 
     subparagraph (D)(vi)) applies in a State as of the beginning 
     of the fiscal year involved, then notwithstanding any other 
     provision of this paragraph, the amount of the grant pursuant 
     to paragraph (1) for the State may not for the fiscal year 
     involved exceed by more than 5 percent the amount of the 
     grant pursuant to this paragraph for the State for the 
     preceding fiscal year, except that the limitation under this 
     clause may not result in a grant pursuant to paragraph (1) 
     for a fiscal year that is less than the minimum amount that 
     applies to the State under such paragraph for such fiscal 
     year.
       ``(ii) Use of amounts involved.--For each of the fiscal 
     years 2007 through 2010, amounts available as a result of the 
     limitation under clause (i) shall be made available by the 
     Secretary as additional amounts for grants pursuant to 
     section 2620, subject to subparagraph (H).
       ``(F) Severity of need.--
       ``(i) Fiscal years beginning with 2011.--If, by January 1, 
     2010, the Secretary notifies the appropriate committees of 
     Congress that the Secretary has developed a severity of need 
     index in accordance with clause (v), the provisions of 
     subparagraphs (A) through (E) shall not apply for fiscal year 
     2011 or any fiscal year thereafter, and the Secretary shall 
     use the severity of need index (as defined in clause (iv)) 
     for the determination of the formula allocations, subject to 
     the Congressional Review Act.
       ``(ii) Subsequent fiscal years.--If, on or before any 
     January 1 that is subsequent to the date referred to in 
     clause (i), the Secretary notifies the appropriate committees 
     of Congress that the Secretary has developed a severity of 
     need index, in accordance with clause (v), for each 
     succeeding fiscal year, the provisions of subparagraphs (A) 
     through (D) shall not apply for the subsequent fiscal year or 
     any fiscal year thereafter, and the Secretary shall use the 
     severity of need index (as defined in clause (iv)) for the 
     determination of the formula allocations, subject to the 
     Congressional Review Act.
       ``(iii) Fiscal year 2013.--The Secretary shall notify the 
     appropriate committees of Congress that the Secretary has 
     developed a severity of need index by January 1, 2012, in 
     accordance with clause (v), and the provisions of 
     subparagraphs (A) through (D) shall not apply for fiscal year 
     2013 or any fiscal year thereafter, and the Secretary shall 
     use the severity of need index (as defined in clause (iv)) 
     for the determination of the formula allocations, subject to 
     the Congressional Review Act.
       ``(iv) Definition of severity of need index.--In this 
     subparagraph, the term `severity of need index' means the 
     index of the relative needs of individuals within the State, 
     as identified by a variety of different factors, and is a 
     factor that is multiplied by the number of living HIV/AIDS 
     cases in the State, providing different weights to those 
     cases based on their needs.
       ``(v) Requirements for secretarial notification.--When the 
     Secretary notifies the appropriate committees of Congress 
     that the Secretary has developed a severity of need index, 
     the Secretary shall provide the following:

       ``(I) Methodology for and rationale behind developing the 
     severity of need index, including information related to the 
     field testing of the severity of need index.
       ``(II) An independent contractor analysis of activities 
     carried out under subclause (I).
       ``(III) Expected changes in funding allocations, given the 
     application of the severity of need index and the elimination 
     of the provisions of subparagraphs (A) through (D).
       ``(IV) Information regarding the process by which the 
     Secretary received community input regarding the application 
     and development of the severity of need index.
       ``(V) Timeline and process for the implementation of the 
     severity of need index to ensure that it is applied in the 
     following fiscal year.

       ``(vi) Annual reports.--Not later than 1 year after the 
     date of enactment of the Ryan White HIV/AIDS Treatment 
     Modernization Act of 2006, and annually thereafter until the 
     Secretary notifies Congress that the Secretary has developed 
     a severity of need index in accordance with this 
     subparagraph, the Secretary shall prepare and submit to the 
     appropriate committees of Congress a report--

       ``(I) that updates progress toward having client level 
     data;
       ``(II) that updates the progress toward having a severity 
     of need index, including information related to the 
     methodology and process for obtaining community input; and
       ``(III) that, as applicable, states whether the Secretary 
     could develop a severity of need index before fiscal year 
     2010.''; and

       (4) by redesignating subparagraph (I) as subparagraph (G).
       (c) Separate ADAP Grants.--Section 2618(a)(2)(G) of the 
     Public Health Service Act (42 U.S.C. 300ff-28(a)(2)(G)), as 
     redesignated by subsection (b)(4) of this section, is 
     amended--
       (1) in clause (i)--
       (A) in the matter preceding subclause (I), by striking 
     ``section 2677'' and inserting ``section 2623'';
       (B) in subclause (II), by striking the period at the end 
     and inserting a semicolon; and
       (C) by adding after and below subclause (II) the following:

     ``which product shall then, as applicable, be increased under 
     subparagraph (H).'';
       (2) in clause (ii)--
       (A) by striking subclauses (I) through (III) and inserting 
     the following:

       ``(I) In general.--From amounts made available under 
     subclause (V), the Secretary shall award supplemental grants 
     to States described in subclause (II) to enable such States 
     to purchase and distribute to eligible individuals under 
     section 2616(b) pharmaceutical therapeutics described under 
     subsections (c)(2) and (e) of such section.
       ``(II) Eligible states.--For purposes of subclause (I), a 
     State shall be an eligible State if the State did not have 
     unobligated funds subject to reallocation under section 
     2618(d) in the previous fiscal year and, in accordance with 
     criteria established by the Secretary, demonstrates a severe 
     need for a grant under this clause. For purposes of 
     determining severe need, the Secretary shall consider 
     eligibility standards, formulary composition, the number of 
     eligible individuals to whom a State is unable to provide 
     therapeutics described in section 2616(a), and an 
     unanticipated increase of eligible individuals with HIV/AIDS.
       ``(III) State requirements.--The Secretary may not make a 
     grant to a State under this clause unless the State agrees 
     that the State will make available (directly or through 
     donations of public or private entities) non-Federal 
     contributions toward the activities to be carried out under 
     the grant in an amount equal to $1 for each $4 of Federal 
     funds provided in the grant, except that the Secretary may 
     waive this subclause if the State has otherwise fully 
     complied with section 2617(d) with respect to the grant year 
     involved. The provisions of this subclause shall apply to 
     States that are not required to comply with such section 
     2617(d).''.

       (B) in subclause (IV), by moving the subclause two ems to 
     the left;
       (C) in subclause (V), by striking ``3 percent'' and 
     inserting ``5 percent''; and
       (D) by striking subclause (VI); and
       (3) by adding at the end the following clause:
       ``(iii) Code-based states; limitation on increase in 
     formula grant.--The limitation under subparagraph (E)(i) 
     applies to grants pursuant to clause (i) of this subparagraph 
     to the same extent and in the same manner as such limitation 
     applies to grants pursuant to paragraph (1), except that the 
     reference to minimum grants does not apply for purposes of 
     this clause. Amounts available as a result of the limitation 
     under the preceding sentence shall be made available by the 
     Secretary as additional amounts for grants under clause (ii) 
     of this subparagraph.''.
       (d) Hold Harmless.--Section 2618(a)(2) of the Public Health 
     Service Act (42 U.S.C. 300ff-28(a)(2)), as amended by 
     subsection (b)(4) of this section, is amended by adding at 
     the end the following subparagraph:
       ``(H) Increase in formula grants.--
       ``(i) In general.--For each of the fiscal years 2007 
     through 2009, the Secretary shall ensure, subject to clauses 
     (ii) through (iv), that the total for a State of the grant 
     pursuant to paragraph (1) and the grant pursuant

[[Page 20459]]

     to subparagraph (G) is not less than 95 percent of such total 
     for the State for the preceding fiscal year, except that any 
     increase under this clause--

       ``(I) may not result in a grant pursuant to paragraph (1) 
     that is more than 95 percent of the amount of such grant for 
     the preceding fiscal year; and
       ``(II) may not result in a grant pursuant to subparagraph 
     (G) that is more than 95 percent of the amount of such grant 
     for such preceding fiscal year.

       ``(ii) Fiscal year 2007.--For purposes of clause (i) as 
     applied for fiscal year 2007, the references in such clause 
     to subparagraph (G) are deemed to be references to 
     subparagraph (I) as such subparagraph was in effect for 
     fiscal year 2006.
       ``(iii) Source of funds for increase.--

       ``(I) In general.--From the amount reserved under section 
     2623(b)(2) for a fiscal year, and from amounts available for 
     such section pursuant to subsection (d) of this section, the 
     Secretary shall make available such amounts as may be 
     necessary to comply with clause (i).
       ``(II) Pro rata reduction.--If the amounts referred to in 
     subclause (I) for a fiscal year are insufficient to fully 
     comply with clause (i) for the year, the Secretary, in order 
     to provide the additional funds necessary for such 
     compliance, shall reduce on a pro rata basis the amount of 
     each grant pursuant to paragraph (1) for the fiscal year, 
     other than grants for States for which increases under clause 
     (i) apply and other than States described in paragraph 
     (1)(A)(i)(I). A reduction under the preceding sentence may 
     not be made in an amount that would result in the State 
     involved becoming eligible for such an increase.

       ``(iv) Applicability.--This paragraph may not be construed 
     as having any applicability after fiscal year 2009.''.
       (e) Administrative Expenses; Clinical Quality Management.--
     Section 2618(b) of the Public Health Service Act (42 U.S.C. 
     300ff-28(b)) is amended--
       (1) by redesignating paragraphs (2) through (7) as 
     paragraphs (1) through (6);
       (2) in paragraph (2) (as so redesignated)--
       (A) by striking ``paragraph (5)'' and inserting ``paragraph 
     (4)''; and
       (B) by striking ``paragraph (6)'' and inserting ``paragraph 
     (5)'';
       (3) in paragraph (3) (as so redesignated)--
       (A) by amending subparagraph (A) to read as follows:
       ``(A) In general.--Subject to paragraph (4,) and except as 
     provided in paragraph (5), a State may not use more than 10 
     percent of amounts received under a grant awarded under 
     section 2611 for administration.'';
       (B) by redesignating subparagraphs (B) and (C) as 
     subparagraphs (C) and (D), respectively;
       (C) by inserting after subparagraph (A) the following:
       ``(B) Allocations.--In the case of entities and 
     subcontractors to which a State allocates amounts received by 
     the State under a grant under section 2611, the State shall 
     ensure that, of the aggregate amount so allocated, the total 
     of the expenditures by such entities for administrative 
     expenses does not exceed 10 percent (without regard to 
     whether particular entities expend more than 10 percent for 
     such expenses).'';
       (D) in subparagraph (C) (as so redesignated), by inserting 
     before the period the following: ``, including a clinical 
     quality management program under subparagraph (E)''; and
       (E) by adding at the end the following:
       ``(E) Clinical quality management.--
       ``(i) Requirement.--Each State that receives a grant under 
     section 2611 shall provide for the establishment of a 
     clinical quality management program to assess the extent to 
     which HIV health services provided to patients under the 
     grant are consistent with the most recent Public Health 
     Service guidelines for the treatment of HIV/AIDS and related 
     opportunistic infection, and as applicable, to develop 
     strategies for ensuring that such services are consistent 
     with the guidelines for improvement in the access to and 
     quality of HIV health services.
       ``(ii) Use of funds.--

       ``(I) In general.--From amounts received under a grant 
     awarded under section 2611 for a fiscal year, a State may use 
     for activities associated with the clinical quality 
     management program required in clause (i) not to exceed the 
     lesser of--

       ``(aa) 5 percent of amounts received under the grant; or
       ``(bb) $3,000,000.

       ``(II) Relation to limitation on administrative expenses.--
     The costs of a clinical quality management program under 
     clause (i) may not be considered administrative expenses for 
     purposes of the limitation established in subparagraph 
     (A).'';

       (4) in paragraph (4) (as so redesignated)--
       (A) by striking ``paragraph (6)'' and inserting ``paragraph 
     (5)''; and
       (B) by striking ``paragraphs (3) and (4)'' and inserting 
     ``paragraphs (2) and (3)''; and
       (5) in paragraph (5) (as so redesignated), by striking 
     ``paragraphs (3)'' and all that follows through ``(5),'' and 
     inserting the following: ``paragraphs (2) and (3), may, 
     notwithstanding paragraphs (2) through (4),''.
       (f) Reallocation for Supplemental Grants.--Section 2618(d) 
     of the Public Health Service Act (42 U.S.C. 300ff-28(d)) is 
     amended to read as follows:
       ``(d) Reallocation.--Any portion of a grant made to a State 
     under section 2611 for a fiscal year that has not been 
     obligated as described in subsection (c) ceases to be 
     available to the State and shall be made available by the 
     Secretary for grants under section 2620, in addition to 
     amounts made available for such grants under section 
     2623(b)(2).''.
       (g) Definitions; Other Technical Amendments.--Section 
     2618(a) of the Public Health Service Act (42 U.S.C. 300ff-
     28(a)) is amended--
       (1) in paragraph (1), in the matter preceding subparagraph 
     (A), by striking ``section 2677'' and inserting ``section 
     2623'';
       (2) in paragraph (1)(A)--
       (A) in the matter preceding clause (i), by striking ``each 
     of the several States and the District of Columbia'' and 
     inserting ``each of the 50 States, the District of Columbia, 
     Guam, and the Virgin Islands (referred to in this paragraph 
     as a `covered State')''; and
       (B) in clause (i)--
       (i) in subclause (I), by striking ``State or District'' and 
     inserting ``covered State''; and
       (ii) in subclause (II)--

       (I) by striking ``State or District'' and inserting 
     ``covered State''; and
       (II) by inserting ``and'' after the semicolon; and

       (3) in paragraph (1)(B), by striking ``each territory of 
     the United States, as defined in paragraph (3),'' and 
     inserting ``each territory other than Guam and the Virgin 
     Islands'';
       (4) in paragraph (2)(C)(i), by striking ``or territory''; 
     and
       (5) by striking paragraph (3).

     SEC. 204. ADDITIONAL AMENDMENTS TO SUBPART I OF PART B.

       (a) References to Part B.--Subpart I of part B of title 
     XXVI of the Public Health Service Act (42 U.S.C. 300ff-21 et 
     seq.) is amended by striking ``this part'' each place such 
     term appears and inserting ``section 2611''.
       (b) Hepatitis.--Section 2614(a)(3) of the Public Health 
     Service Act (42 U.S.C. 300ff-24(a)(3)) is amended by 
     inserting ``, including specialty care and vaccinations for 
     hepatitis co-infection,'' after ``health services''.
       (c) Application for Grant.--
       (1) Coordination.--Section 2617(b) of the Public Health 
     Service Act (42 U.S.C. 300ff-27(b)) is amended--
       (A) by redesignating paragraphs (4) through (6) as 
     paragraphs (5) through (7), respectively;
       (B) by inserting after paragraph (3), the following:
       ``(4) the designation of a lead State agency that shall--
       ``(A) administer all assistance received under this part;
       ``(B) conduct the needs assessment and prepare the State 
     plan under paragraph (3);
       ``(C) prepare all applications for assistance under this 
     part;
       ``(D) receive notices with respect to programs under this 
     title;
       ``(E) every 2 years, collect and submit to the Secretary 
     all audits, consistent with Office of Management and Budget 
     circular A133, from grantees within the State, including 
     audits regarding funds expended in accordance with this part; 
     and
       ``(F) carry out any other duties determined appropriate by 
     the Secretary to facilitate the coordination of programs 
     under this title.'';
       (C) in paragraph (5) (as so redesignated)--
       (i) in subparagraph (E), by striking ``and'' at the end; 
     and
       (ii) by inserting after subparagraph (F) the following:
       ``(G) includes key outcomes to be measured by all entities 
     in the State receiving assistance under this title; and''; 
     and
       (D) in paragraph (7) (as so redesignated), in subparagraph 
     (A)--
       (i) by striking ``paragraph (5)'' and inserting ``paragraph 
     (6)''; and
       (ii) by striking ``paragraph (4)'' and inserting 
     ``paragraph (5)''.
       (2) Native american representation.--Section 2617(b)(6) of 
     the Public Health Service Act, as redesignated by paragraph 
     (1)(A) of this subsection, is amended by inserting before 
     ``representatives of grantees'' the following: ``members of a 
     Federally recognized Indian tribe as represented in the 
     State,''.
       (3) Payer of last resort.--Section 2617(b)(7)(F)(ii) of the 
     Public Health Service Act, as redesignated by paragraph 
     (1)(A) of this subsection, is amended by inserting before the 
     semicolon the following: ``(except for a program administered 
     by or providing the services of the Indian Health Service)''.
       (d) Matching Funds; Applicability of Requirement.--Section 
     2617(d)(3) of the Public Health Service Act (42 U.S.C. 300ff-
     27(d)(3)) is amended--
       (1) in subparagraph (A), by striking ``acquired immune 
     deficiency syndrome'' and inserting ``HIV/AIDS''; and
       (2) in subparagraph (C), by striking ``acquired immune 
     deficiency syndrome'' and inserting ``HIV/AIDS''.

     SEC. 205. SUPPLEMENTAL GRANTS ON BASIS OF DEMONSTRATED NEED.

       Subpart I of part B of title XXVI of the Public Health 
     Service Act (42 U.S.C. 300ff-21 et seq.) is amended--
       (1) by redesignating section 2620 as section 2621; and
       (2) by inserting after section 2619 the following:

[[Page 20460]]



     ``SEC. 2620. SUPPLEMENTAL GRANTS.

       ``(a) In General.--For the purpose of providing services 
     described in section 2612(a), the Secretary shall make grants 
     to States--
       ``(1) whose applications under section 2617 have 
     demonstrated the need in the State, on an objective and 
     quantified basis, for supplemental financial assistance to 
     provide such services; and
       ``(2) that did not, for the most recent grant year pursuant 
     to section 2618(a)(1) or 2618(a)(2)(G)(i) for which data is 
     available, have more than 2 percent of grant funds under such 
     sections canceled or covered by any waivers under section 
     2622(c).
       ``(b) Demonstrated Need.--The factors considered by the 
     Secretary in determining whether an eligible area has a 
     demonstrated need for purposes of subsection (a)(1) may 
     include any or all of the following:
       ``(1) The unmet need for such services, as determined under 
     section 2617(b).
       ``(2) An increasing need for HIV/AIDS-related services, 
     including relative rates of increase in the number of cases 
     of HIV/AIDS.
       ``(3) The relative rates of increase in the number of cases 
     of HIV/AIDS within new or emerging subpopulations.
       ``(4) The current prevalence of HIV/AIDS.
       ``(5) Relevant factors related to the cost and complexity 
     of delivering health care to individuals with HIV/AIDS in the 
     eligible area.
       ``(6) The impact of co-morbid factors, including co-
     occurring conditions, determined relevant by the Secretary.
       ``(7) The prevalence of homelessness.
       ``(8) The prevalence of individuals described under section 
     2602(b)(2)(M).
       ``(9) The relevant factors that limit access to health 
     care, including geographic variation, adequacy of health 
     insurance coverage, and language barriers.
       ``(10) The impact of a decline in the amount received 
     pursuant to section 2618 on services available to all 
     individuals with HIV/AIDS identified and eligible under this 
     title.
       ``(c) Priority in Making Grants.--The Secretary shall 
     provide funds under this section to a State to address the 
     decline in services related to the decline in the amounts 
     received pursuant to section 2618 consistent with the grant 
     award to the State for fiscal year 2006, to the extent that 
     the factor under subsection (b)(10) (relating to a decline in 
     funding) applies to the State.
       ``(d) Core Medical Services.--The provisions of section 
     2612(b) apply with respect to a grant under this section to 
     the same extent and in the same manner as such provisions 
     apply with respect to a grant made pursuant to section 
     2618(a)(1).
       ``(e) Applicability of Grant Authority.--The authority to 
     make grants under this section applies beginning with the 
     first fiscal year for which amounts are made available for 
     such grants under section 2623(b)(1).''.

     SEC. 206. EMERGING COMMUNITIES.

       Section 2621 of the Public Health Service Act, as 
     redesignated by section 205(1) of this Act, is amended--
       (1) in the heading for the section, by striking 
     ``SUPPLEMENTAL GRANTS'' and inserting ``EMERGING 
     COMMUNITIES'';
       (2) in subsection (b)--
       (A) in paragraph (2), by striking ``and'' at the end;
       (B) by redesignating paragraph (3) as paragraph (4); and
       (C) by inserting after paragraph (2) the following:
       ``(3) agree that the grant will be used to provide funds 
     directly to emerging communities in the State, separately 
     from other funds under this title that are provided by the 
     State to such communities; and''.
       (3) by striking subsections (d) and (e) and inserting the 
     following:
       ``(d) Definitions of Emerging Community.--For purposes of 
     this section, the term `emerging community' means a 
     metropolitan area (as defined in section 2607) for which 
     there has been reported to and confirmed by the Director of 
     the Centers for Disease Control and Prevention a cumulative 
     total of at least 500, but fewer than 1,000, cases of AIDS 
     during the most recent period of 5 calendar years for which 
     such data are available.
       ``(e) Continued Status as Emerging Community.--
     Notwithstanding any other provision of this section, a 
     metropolitan area that is an emerging community for a fiscal 
     year continues to be an emerging community until the 
     metropolitan area fails, for three consecutive fiscal years--
       ``(1) to meet the requirements of subsection (d); and
       ``(2) to have a cumulative total of 750 or more living 
     cases of AIDS (reported to and confirmed by the Director of 
     the Centers for Disease Control and Prevention) as of 
     December 31 of the most recent calendar year for which such 
     data is available.
       ``(f) Distribution.--The amount of a grant under subsection 
     (a) for a State for a fiscal year shall be an amount equal to 
     the product of--
       ``(1) the amount available under section 2623(b)(1) for the 
     fiscal year; and
       ``(2) a percentage equal to the ratio constituted by the 
     number of living cases of HIV/AIDS in emerging communities in 
     the State to the sum of the respective numbers of such cases 
     in such communities for all States.''.

     SEC. 207. TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF GRANT 
                   FUNDS.

       Subpart I of part B of title XXVI of the Public Health 
     Service Act (42 U.S.C. 300ff-21 et seq.), as amended by 
     section 205, is further amended by adding at the end the 
     following:

     ``SEC. 2622. TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF 
                   GRANT FUNDS.

       ``(a) Obligation by End of Grant Year.--Effective for 
     fiscal year 2007 and subsequent fiscal years, funds from a 
     grant award made to a State for a fiscal year pursuant to 
     section 2618(a)(1) or 2618(a)(2)(G), or under section 2620 or 
     2621, are available for obligation by the State through the 
     end of the one-year period beginning on the date in such 
     fiscal year on which funds from the award first become 
     available to the State (referred to in this section as the 
     `grant year for the award'), except as provided in subsection 
     (c)(1).
       ``(b) Supplemental Grants; Cancellation of Unobligated 
     Balance of Grant Award.--Effective for fiscal year 2007 and 
     subsequent fiscal years, if a grant award made to a State for 
     a fiscal year pursuant to section 2618(a)(2)(G)(ii), or under 
     section 2620 or 2621, has an unobligated balance as of the 
     end of the grant year for the award--
       ``(1) the Secretary shall cancel that unobligated balance 
     of the award, and shall require the State to return any 
     amounts from such balance that have been disbursed to the 
     State; and
       ``(2) the funds involved shall be made available by the 
     Secretary as additional amounts for grants pursuant to 
     section 2620 for the first fiscal year beginning after the 
     fiscal year in which the Secretary obtains the information 
     necessary for determining that the balance is required under 
     paragraph (1) to be canceled, except that the availability of 
     the funds for such grants is subject to section 2618(a)(2)(H) 
     as applied for such year.
       ``(c) Formula Grants; Cancellation of Unobligated Balance 
     of Grant Award; Waiver Permitting Carryover.--
       ``(1) In general.--Effective for fiscal year 2007 and 
     subsequent fiscal years, if a grant award made to a State for 
     a fiscal year pursuant to section 2618(a)(1) or 
     2618(a)(2)(G)(i) has an unobligated balance as of the end of 
     the grant year for the award, the Secretary shall cancel that 
     unobligated balance of the award, and shall require the State 
     to return any amounts from such balance that have been 
     disbursed to the State, unless--
       ``(A) before the end of the grant year, the State submits 
     to the Secretary a written application for a waiver of the 
     cancellation, which application includes a description of the 
     purposes for which the State intends to expend the funds 
     involved; and
       ``(B) the Secretary approves the waiver.
       ``(2) Expenditure by end of carryover year.--With respect 
     to a waiver under paragraph (1) that is approved for a 
     balance that is unobligated as of the end of a grant year for 
     an award:
       ``(A) The unobligated funds are available for expenditure 
     by the State involved for the one-year period beginning upon 
     the expiration of the grant year (referred to in this section 
     as the `carryover year').
       ``(B) If the funds are not expended by the end of the 
     carryover year, the Secretary shall cancel that unexpended 
     balance of the award, and shall require the State to return 
     any amounts from such balance that have been disbursed to the 
     State.
       ``(3) Use of cancelled balances.--In the case of any 
     balance of a grant award that is cancelled under paragraph 
     (1) or (2)(B), the grant funds involved shall be made 
     available by the Secretary as additional amounts for grants 
     under section 2620 for the first fiscal year beginning after 
     the fiscal year in which the Secretary obtains the 
     information necessary for determining that the balance is 
     required under such paragraph to be canceled, except that the 
     availability of the funds for such grants is subject to 
     section 2618(a)(2)(H) as applied for such year.
       ``(4) Corresponding reduction in future grant.--
       ``(A) In general.--In the case of a State for which a 
     balance from a grant award made pursuant to section 
     2618(a)(1) or 2618(a)(2)(G)(i) is unobligated as of the end 
     of the grant year for the award--
       ``(i) the Secretary shall reduce, by the same amount as 
     such unobligated balance, the amount of the grant under such 
     section for the first fiscal year beginning after the fiscal 
     year in which the Secretary obtains the information necessary 
     for determining that such balance was unobligated as of the 
     end of the grant year (which requirement for a reduction 
     applies without regard to whether a waiver under paragraph 
     (1) has been approved with respect to such balance); and
       ``(ii) the grant funds involved in such reduction shall be 
     made available by the Secretary as additional funds for 
     grants under section 2620 for such first fiscal year, subject 
     to section 2618(a)(2)(H);
     except that this subparagraph does not apply to the State if 
     the amount of the unobligated balance was 2 percent or less.
       ``(B) Relation to increases in grant.--A reduction under 
     subparagraph (A) for a State for a fiscal year may not be 
     taken into account in applying section 2618(a)(2)(H) with 
     respect to the State for the subsequent fiscal year.
       ``(d) Treatment of Drug Rebates.--For purposes of this 
     section, funds that are drug

[[Page 20461]]

     rebates referred to in section 2616(g) may not be considered 
     part of any grant award referred to in subsection (a).''.

     SEC. 208. AUTHORIZATION OF APPROPRIATIONS FOR SUBPART I OF 
                   PART B.

       Subpart I of part B of title XXVI of the Public Health 
     Service Act (42 U.S.C. 300ff-21 et seq.), as amended by 
     section 207, is further amended by adding at the end the 
     following:

     ``SEC. 2623. AUTHORIZATION OF APPROPRIATIONS.

       ``(a) In General.--For the purpose of carrying out this 
     subpart, there are authorized to be appropriated 
     $1,195,500,000 for fiscal year 2007, $1,239,500,000 for 
     fiscal year 2008, $1,285,200,000 for fiscal year 2009, 
     $1,332,600,000 for fiscal year 2010, and $1,381,700,000 for 
     fiscal year 2011. Amounts appropriated under the preceding 
     sentence for a fiscal year are available for obligation by 
     the Secretary until the end of the second succeeding fiscal 
     year.
       ``(b) Reservation of Amounts.--
       ``(1) Emerging communities.--Of the amount appropriated 
     under subsection (a) for a fiscal year, the Secretary shall 
     reserve $5,000,000 for grants under section 2621.
       ``(2) Supplemental grants.--
       ``(A) In general.--Of the amount appropriated under 
     subsection (a) for a fiscal year in excess of the 2006 
     adjusted amount, the Secretary shall reserve \1/3\ for grants 
     under section 2620, except that the availability of the 
     reserved funds for such grants is subject to section 
     2618(a)(2)(H) as applied for such year, and except that any 
     amount appropriated exclusively for carrying out section 2616 
     (and, accordingly, distributed under section 2618(a)(2)(G)) 
     is not subject to this subparagraph.
       ``(B) 2006 adjusted amount.--For purposes of subparagraph 
     (A), the term `2006 adjusted amount' means the amount 
     appropriated for fiscal year 2006 under section 2677(b) (as 
     such section was in effect for such fiscal year), excluding 
     any amount appropriated for such year exclusively for 
     carrying out section 2616 (and, accordingly, distributed 
     under section 2618(a)(2)(I), as so in effect).''.

     SEC. 209. EARLY DIAGNOSIS GRANT PROGRAM.

       Section 2625 of the Public Health Service Act (42 U.S.C. 
     300ff-33) is amended to read as follows:

     ``SEC. 2625. EARLY DIAGNOSIS GRANT PROGRAM.

       ``(a) In General.--In the case of States whose laws or 
     regulations are in accordance with subsection (b), the 
     Secretary, acting through the Centers for Disease Control and 
     Prevention, shall make grants to such States for the purposes 
     described in subsection (c).
       ``(b) Description of Compliant States.--For purposes of 
     subsection (a), the laws or regulations of a State are in 
     accordance with this subsection if, under such laws or 
     regulations (including programs carried out pursuant to the 
     discretion of State officials), both of the policies 
     described in paragraph (1) are in effect, or both of the 
     policies described in paragraph (2) are in effect, as 
     follows:
       ``(1)(A) Voluntary opt-out testing of pregnant women.
       ``(B) Universal testing of newborns.
       ``(2)(A) Voluntary opt-out testing of clients at sexually 
     transmitted disease clinics.
       ``(B) Voluntary opt-out testing of clients at substance 
     abuse treatment centers.

     The Secretary shall periodically ensure that the applicable 
     policies are being carried out and recertify compliance.
       ``(c) Use of Funds.--A State may use funds provided under 
     subsection (a) for HIV/AIDS testing (including rapid 
     testing), prevention counseling, treatment of newborns 
     exposed to HIV/AIDS, treatment of mothers infected with HIV/
     AIDS, and costs associated with linking those diagnosed with 
     HIV/AIDS to care and treatment for HIV/AIDS.
       ``(d) Application.--A State that is eligible for the grant 
     under subsection (a) shall submit an application to the 
     Secretary, in such form, in such manner, and containing such 
     information as the Secretary may require.
       ``(e) Limitation on Amount of Grant.--A grant under 
     subsection (a) to a State for a fiscal year may not be made 
     in an amount exceeding $10,000,000.
       ``(f) Rule of Construction.--Nothing in this section shall 
     be construed to pre-empt State laws regarding HIV/AIDS 
     counseling and testing.
       ``(g) Definitions.--In this section:
       ``(1) The term `voluntary opt-out testing' means HIV/AIDS 
     testing--
       ``(A) that is administered to an individual seeking other 
     health care services; and
       ``(B) in which--
       ``(i) pre-test counseling is not required but the 
     individual is informed that the individual will receive an 
     HIV/AIDS test and the individual may opt out of such testing; 
     and
       ``(ii) for those individuals with a positive test result, 
     post-test counseling (including referrals for care) is 
     provided and confidentiality is protected.
       ``(2) The term `universal testing of newborns' means HIV/
     AIDS testing that is administered within 48 hours of delivery 
     to--
       ``(A) all infants born in the State; or
       ``(B) all infants born in the State whose mother's HIV/AIDS 
     status is unknown at the time of delivery.
       ``(h) Authorization of Appropriations.--Of the funds 
     appropriated annually to the Centers for Disease Control and 
     Prevention for HIV/AIDS prevention activities, $30,000,000 
     shall be made available for each of the fiscal years 2007 
     through 2011 for grants under subsection (a), of which 
     $20,000,000 shall be made available for grants to States with 
     the policies described in subsection (b)(1), and $10,000,000 
     shall be made available for grants to States with the 
     policies described in subsection (b)(2). Funds provided under 
     this section are available until expended.''.

     SEC. 210. CERTAIN PARTNER NOTIFICATION PROGRAMS; 
                   AUTHORIZATION OF APPROPRIATIONS.

       Section 2631(d) of the Public Health Service Act (42 U.S.C. 
     300ff-38(d)) is amended by striking ``there are'' and all 
     that follows and inserting the following: ``there is 
     authorized to be appropriated $10,000,000 for each of the 
     fiscal years 2007 through 2011.''.

                 TITLE III--EARLY INTERVENTION SERVICES

     SEC. 301. ESTABLISHMENT OF PROGRAM; CORE MEDICAL SERVICES.

       (a) In General.--Section 2651 of the Public Health Service 
     Act (42 U.S.C. 300ff-51) is amended to read as follows:

     ``SEC. 2651. ESTABLISHMENT OF A PROGRAM.

       ``(a) In General.--For the purposes described in subsection 
     (b), the Secretary, acting through the Administrator of the 
     Health Resources and Services Administration, may make grants 
     to public and nonprofit private entities specified in section 
     2652(a).
       ``(b) Requirements.--
       ``(1) In general.--The Secretary may not make a grant under 
     subsection (a) unless the applicant for the grant agrees to 
     expend the grant only for--
       ``(A) core medical services described in subsection (c);
       ``(B) support services described in subsection (d); and
       ``(C) administrative expenses as described in section 
     2664(g)(3).
       ``(2) Early intervention services.--An applicant for a 
     grant under subsection (a) shall expend not less than 50 
     percent of the amount received under the grant for the 
     services described in subparagraphs (B) through (E) of 
     subsection (e)(1) for individuals with HIV/AIDS.
       ``(c) Required Funding for Core Medical Services.--
       ``(1) In general.--With respect to a grant under subsection 
     (a) to an applicant for a fiscal year, the applicant shall, 
     of the portion of the grant remaining after reserving amounts 
     for purposes of paragraphs (3) and (5) of section 2664(g), 
     use not less than 75 percent to provide core medical services 
     that are needed in the area involved for individuals with 
     HIV/AIDS who are identified and eligible under this title 
     (including services regarding the co-occurring conditions of 
     the individuals).
       ``(2) Waiver.--
       ``(A) The Secretary shall waive the application of 
     paragraph (1) with respect to an applicant for a grant if the 
     Secretary determines that, within the service area of the 
     applicant--
       ``(i) there are no waiting lists for AIDS Drug Assistance 
     Program services under section 2616; and
       ``(ii) core medical services are available to all 
     individuals with HIV/AIDS identified and eligible under this 
     title.
       ``(B) Notification of waiver status.--When informing an 
     applicant that a grant under subsection (a) is being made for 
     a fiscal year, the Secretary shall inform the applicant 
     whether a waiver under subparagraph (A) is in effect for the 
     fiscal year.
       ``(3) Core medical services.--For purposes of this 
     subsection, the term `core medical services', with respect to 
     an individual with HIV/AIDS (including the co-occurring 
     conditions of the individual) means the following services:
       ``(A) Outpatient and ambulatory health services.
       ``(B) AIDS Drug Assistance Program treatments under section 
     2616.
       ``(C) AIDS pharmaceutical assistance.
       ``(D) Oral health care.
       ``(E) Early intervention services described in subsection 
     (e).
       ``(F) Health insurance premium and cost sharing assistance 
     for low-income individuals in accordance with section 2615.
       ``(G) Home health care.
       ``(H) Medical nutrition therapy.
       ``(I) Hospice services.
       ``(J) Home and community-based health services as defined 
     under section 2614(c).
       ``(K) Mental health services.
       ``(L) Substance abuse outpatient care.
       ``(M) Medical case management, including treatment 
     adherence services.
       ``(d) Support Services.--
       ``(1) In general.--For purposes of this section, the term 
     `support services' means services, subject to the approval of 
     the Secretary, that are needed for individuals with HIV/AIDS 
     to achieve their medical outcomes (such as respite care for 
     persons caring for individuals with HIV/AIDS, outreach 
     services, medical transportation, linguistic services, and 
     referrals for health care and support services).
       ``(2) Definition of medical outcomes.--In this section, the 
     term `medical outcomes' means those outcomes affecting the 
     HIV-related clinical status of an individual with HIV/AIDS.
       ``(e) Specification of Early Intervention Services.--

[[Page 20462]]

       ``(1) In general.--The early intervention services referred 
     to in this section are--
       ``(A) counseling individuals with respect to HIV/AIDS in 
     accordance with section 2662;
       ``(B) testing individuals with respect to HIV/AIDS, 
     including tests to confirm the presence of the disease, tests 
     to diagnose the extent of the deficiency in the immune 
     system, and tests to provide information on appropriate 
     therapeutic measures for preventing and treating the 
     deterioration of the immune system and for preventing and 
     treating conditions arising from HIV/AIDS;
       ``(C) referrals described in paragraph (2);
       ``(D) other clinical and diagnostic services regarding HIV/
     AIDS, and periodic medical evaluations of individuals with 
     HIV/AIDS; and
       ``(E) providing the therapeutic measures described in 
     subparagraph (B).
       ``(2) Referrals.--The services referred to in paragraph 
     (1)(C) are referrals of individuals with HIV/AIDS to 
     appropriate providers of health and support services, 
     including, as appropriate--
       ``(A) to entities receiving amounts under part A or B for 
     the provision of such services;
       ``(B) to biomedical research facilities of institutions of 
     higher education that offer experimental treatment for such 
     disease, or to community-based organizations or other 
     entities that provide such treatment; or
       ``(C) to grantees under section 2671, in the case of a 
     pregnant woman.
       ``(3) Requirement of availability of all early intervention 
     services through each grantee.--
       ``(A) In general.--The Secretary may not make a grant under 
     subsection (a) unless the applicant for the grant agrees that 
     each of the early intervention services specified in 
     paragraph (2) will be available through the grantee. With 
     respect to compliance with such agreement, such a grantee may 
     expend the grant to provide the early intervention services 
     directly, and may expend the grant to enter into agreements 
     with public or nonprofit private entities, or private for-
     profit entities if such entities are the only available 
     provider of quality HIV care in the area, under which the 
     entities provide the services.
       ``(B) Other requirements.--Grantees described in--
       ``(i) subparagraphs (A), (D), (E), and (F) of section 
     2652(a)(1) shall use not less than 50 percent of the amount 
     of such a grant to provide the services described in 
     subparagraphs (A), (B), (D), and (E) of paragraph (1) 
     directly and on-site or at sites where other primary care 
     services are rendered; and
       ``(ii) subparagraphs (B) and (C) of section 2652(a)(1) 
     shall ensure the availability of early intervention services 
     through a system of linkages to community-based primary care 
     providers, and to establish mechanisms for the referrals 
     described in paragraph (1)(C), and for follow-up concerning 
     such referrals.''.
       (b) Administrative Expenses; Clinical Quality Management 
     Program.--Section 2664(g) of the Public Health Service Act 
     (42 U.S.C. 300ff-64(g)) is amended--
       (1) in paragraph (3), by amending the paragraph to read as 
     follows:
       ``(3) the applicant will not expend more than 10 percent of 
     the grant for administrative expenses with respect to the 
     grant, including planning and evaluation, except that the 
     costs of a clinical quality management program under 
     paragraph (5) may not be considered administrative expenses 
     for purposes of such limitation;''; and
       (2) in paragraph (5), by inserting ``clinical'' before 
     ``quality management''.

     SEC. 302. ELIGIBLE ENTITIES; PREFERENCES; PLANNING AND 
                   DEVELOPMENT GRANTS.

       (a) Minimum Qualification of Grantees.--Section 2652(a) of 
     the Public Health Service Act (42 U.S.C. 300ff-52(a)) is 
     amended to read as follows:
       ``(a) Eligible Entities.--
       ``(1) In general.--The entities referred to in section 
     2651(a) are public entities and nonprofit private entities 
     that are--
       ``(A) federally-qualified health centers under section 
     1905(l)(2)(B) of the Social Security Act;
       ``(B) grantees under section 1001 (regarding family 
     planning) other than States;
       ``(C) comprehensive hemophilia diagnostic and treatment 
     centers;
       ``(D) rural health clinics;
       ``(E) health facilities operated by or pursuant to a 
     contract with the Indian Health Service;
       ``(F) community-based organizations, clinics, hospitals and 
     other health facilities that provide early intervention 
     services to those persons infected with HIV/AIDS through 
     intravenous drug use; or
       ``(G) nonprofit private entities that provide comprehensive 
     primary care services to populations at risk of HIV/AIDS, 
     including faith-based and community-based organizations.
       ``(2) Underserved populations.--Entities described in 
     paragraph (1) shall serve underserved populations which may 
     include minority populations and Native American populations, 
     ex-offenders, individuals with comorbidities including 
     hepatitis B or C, mental illness, or substance abuse, low-
     income populations, inner city populations, and rural 
     populations.''.
       (b) Preferences in Making Grants.--Section 2653 of the 
     Public Health Service Act (42 U.S.C. 300ff-53) is amended--
       (1) in subsection (b)(1)--
       (A) in subparagraph (A), by striking ``acquired immune 
     deficiency syndrome'' and inserting ``HIV/AIDS''; and
       (B) in subparagraph (D), by inserting before the semicolon 
     the following: ``and the number of cases of individuals co-
     infected with HIV/AIDS and hepatitis B or C''; and
       (2) in subsection (d)(2), by striking ``special 
     consideration'' and inserting ``preference''.
       (c) Planning and Development Grants.--Section 2654(c) of 
     the Public Health Service Act (42 U.S.C. 300ff-54(c)) is 
     amended--
       (1) in paragraph (1)--
       (A) in subparagraph (A), by striking ``HIV''; and
       (B) in subparagraph (B), by striking ``HIV'' and inserting 
     ``HIV/AIDS''; and
       (2) in paragraph (3), by striking ``or underserved 
     communities'' and inserting ``areas or to underserved 
     populations''.

     SEC. 303. AUTHORIZATION OF APPROPRIATIONS.

       Section 2655 of the Public Health Service Act (42 U.S.C. 
     300ff-55) is amended by striking ``such sums'' and all that 
     follows through ``2005'' and inserting ``, $218,600,000 for 
     fiscal year 2007, $226,700,000 for fiscal year 2008, 
     $235,100,000 for fiscal year 2009, $243,800,000 for fiscal 
     year 2010, and $252,800,000 for fiscal year 2011''.

     SEC. 304. CONFIDENTIALITY AND INFORMED CONSENT.

       Section 2661 of the Public Health Service Act (42 U.S.C. 
     300ff-61) is amended to read as follows:

     ``SEC. 2661. CONFIDENTIALITY AND INFORMED CONSENT.

       ``(a) Confidentiality.--The Secretary may not make a grant 
     under this part unless, in the case of any entity applying 
     for a grant under section 2651, the entity agrees to ensure 
     that information regarding the receipt of early intervention 
     services pursuant to the grant is maintained confidentially 
     in a manner not inconsistent with applicable law.
       ``(b) Informed Consent.--The Secretary may not make a grant 
     under this part unless the applicant for the grant agrees 
     that, in testing an individual for HIV/AIDS, the applicant 
     will test an individual only after the individual confirms 
     that the decision of the individual with respect to 
     undergoing such testing is voluntarily made.''.

     SEC. 305. PROVISION OF CERTAIN COUNSELING SERVICES.

       Section 2662 of the Public Health Service Act (42 U.S.C. 
     300ff-62) is amended to read as follows:

     ``SEC. 2662. PROVISION OF CERTAIN COUNSELING SERVICES.

       ``(a) Counseling of Individuals With Negative Test 
     Results.--The Secretary may not make a grant under this part 
     unless the applicant for the grant agrees that, if the 
     results of testing conducted for HIV/AIDS indicate that an 
     individual does not have such condition, the applicant will 
     provide the individual information, including--
       ``(1) measures for prevention of, exposure to, and 
     transmission of HIV/AIDS, hepatitis B, hepatitis C, and other 
     sexually transmitted diseases;
       ``(2) the accuracy and reliability of results of testing 
     for HIV/AIDS, hepatitis B, and hepatitis C;
       ``(3) the significance of the results of such testing, 
     including the potential for developing AIDS, hepatitis B, or 
     hepatitis C;
       ``(4) the appropriateness of further counseling, testing, 
     and education of the individual regarding HIV/AIDS and other 
     sexually transmitted diseases;
       ``(5) if diagnosed with chronic hepatitis B or hepatitis C 
     co-infection, the potential of developing hepatitis-related 
     liver disease and its impact on HIV/AIDS; and
       ``(6) information regarding the availability of hepatitis B 
     vaccine and information about hepatitis treatments.
       ``(b) Counseling of Individuals With Positive Test 
     Results.--The Secretary may not make a grant under this part 
     unless the applicant for the grant agrees that, if the 
     results of testing for HIV/AIDS indicate that the individual 
     has such condition, the applicant will provide to the 
     individual appropriate counseling regarding the condition, 
     including--
       ``(1) information regarding--
       ``(A) measures for prevention of, exposure to, and 
     transmission of HIV/AIDS, hepatitis B, and hepatitis C;
       ``(B) the accuracy and reliability of results of testing 
     for HIV/AIDS, hepatitis B, and hepatitis C; and
       ``(C) the significance of the results of such testing, 
     including the potential for developing AIDS, hepatitis B, or 
     hepatitis C;
       ``(2) reviewing the appropriateness of further counseling, 
     testing, and education of the individual regarding HIV/AIDS 
     and other sexually transmitted diseases; and
       ``(3) providing counseling--
       ``(A) on the availability, through the applicant, of early 
     intervention services;
       ``(B) on the availability in the geographic area of 
     appropriate health care, mental health care, and social and 
     support services, including providing referrals for such 
     services, as appropriate;
       ``(C)(i) that explains the benefits of locating and 
     counseling any individual by whom the infected individual may 
     have been exposed to HIV/AIDS, hepatitis B, or hepatitis

[[Page 20463]]

     C and any individual whom the infected individual may have 
     exposed to HIV/AIDS, hepatitis B, or hepatitis C; and
       ``(ii) that emphasizes it is the duty of infected 
     individuals to disclose their infected status to their sexual 
     partners and their partners in the sharing of hypodermic 
     needles; that provides advice to infected individuals on the 
     manner in which such disclosures can be made; and that 
     emphasizes that it is the continuing duty of the individuals 
     to avoid any behaviors that will expose others to HIV/AIDS, 
     hepatitis B, or hepatitis C; and
       ``(D) on the availability of the services of public health 
     authorities with respect to locating and counseling any 
     individual described in subparagraph (C);
       ``(4) if diagnosed with chronic hepatitis B or hepatitis C 
     co-infection, the potential of developing hepatitis-related 
     liver disease and its impact on HIV/AIDS; and
       ``(5) information regarding the availability of hepatitis B 
     vaccine.
       ``(c) Additional Requirements Regarding Appropriate 
     Counseling.--The Secretary may not make a grant under this 
     part unless the applicant for the grant agrees that, in 
     counseling individuals with respect to HIV/AIDS, the 
     applicant will ensure that the counseling is provided under 
     conditions appropriate to the needs of the individuals.
       ``(d) Counseling of Emergency Response Employees.--The 
     Secretary may not make a grant under this part to a State 
     unless the State agrees that, in counseling individuals with 
     respect to HIV/AIDS, the State will ensure that, in the case 
     of emergency response employees, the counseling is provided 
     to such employees under conditions appropriate to the needs 
     of the employees regarding the counseling.
       ``(e) Rule of Construction Regarding Counseling Without 
     Testing.--Agreements made pursuant to this section may not be 
     construed to prohibit any grantee under this part from 
     expending the grant for the purpose of providing counseling 
     services described in this section to an individual who does 
     not undergo testing for HIV/AIDS as a result of the grantee 
     or the individual determining that such testing of the 
     individual is not appropriate.''.

     SEC. 306. GENERAL PROVISIONS.

       (a) Applicability of Certain Requirements.--Section 2663 of 
     the Public Health Service Act (42 U.S.C. 300ff-63) is amended 
     by striking ``will, without'' and all that follows through 
     ``be carried'' and inserting ``with funds appropriated 
     through this Act will be carried''.
       (b) Additional Required Agreements.--Section 2664(a) of the 
     Public Health Service Act (42 U.S.C. 300ff-64(a)) is 
     amended--
       (1) in paragraph (1)--
       (A) in subparagraph (A), by striking ``and'' at the end;
       (B) in subparagraph (B), by striking ``and'' at the end; 
     and
       (C) by adding at the end the following:
       ``(C) information regarding how the expected expenditures 
     of the grant are related to the planning process for 
     localities funded under part A (including the planning 
     process described in section 2602) and for States funded 
     under part B (including the planning process described in 
     section 2617(b)); and
       ``(D) a specification of the expected expenditures and how 
     those expenditures will improve overall client outcomes, as 
     described in the State plan under section 2617(b);'';
       (2) in paragraph (2), by striking the period and inserting 
     a semicolon; and
       (3) by adding at the end the following:
       ``(3) the applicant agrees to provide additional 
     documentation to the Secretary regarding the process used to 
     obtain community input into the design and implementation of 
     activities related to such grant; and
       ``(4) the applicant agrees to submit, every 2 years, to the 
     lead State agency under section 2617(b)(4) audits, consistent 
     with Office of Management and Budget circular A133, regarding 
     funds expended in accordance with this title and shall 
     include necessary client level data to complete unmet need 
     calculations and Statewide coordinated statements of need 
     process.''.
       (c) Payer of Last Resort.--Section 2664(f)(1)(A) of the 
     Public Health Service Act (42 U.S.C. 300ff-64(f)(1)(A)) is 
     amended by inserting ``(except for a program administered by 
     or providing the services of the Indian Health Service)'' 
     before the semicolon.

             TITLE IV--WOMEN, INFANTS, CHILDREN, AND YOUTH

     SEC. 401. WOMEN, INFANTS, CHILDREN, AND YOUTH.

       Part D of title XXVI of the Public Health Service Act (42 
     U.S.C. 300ff-71 et seq.) is amended to read as follows:

             ``PART D--WOMEN, INFANTS, CHILDREN, AND YOUTH

     ``SEC. 2671. GRANTS FOR COORDINATED SERVICES AND ACCESS TO 
                   RESEARCH FOR WOMEN, INFANTS, CHILDREN, AND 
                   YOUTH.

       ``(a) In General.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, shall award grants to public and nonprofit 
     private entities (including a health facility operated by or 
     pursuant to a contract with the Indian Health Service) for 
     the purpose of providing family-centered care involving 
     outpatient or ambulatory care (directly or through contracts) 
     for women, infants, children, and youth with HIV/AIDS.
       ``(b) Additional Services for Patients and Families.--Funds 
     provided under grants awarded under subsection (a) may be 
     used for the following support services:
       ``(1) Family-centered care including case management.
       ``(2) Referrals for additional services including--
       ``(A) referrals for inpatient hospital services, treatment 
     for substance abuse, and mental health services; and
       ``(B) referrals for other social and support services, as 
     appropriate.
       ``(3) Additional services necessary to enable the patient 
     and the family to participate in the program established by 
     the applicant pursuant to such subsection including services 
     designed to recruit and retain youth with HIV.
       ``(4) The provision of information and education on 
     opportunities to participate in HIV/AIDS-related clinical 
     research.
       ``(c) Coordination With Other Entities.--A grant awarded 
     under subsection (a) may be made only if the applicant 
     provides an agreement that includes the following:
       ``(1) The applicant will coordinate activities under the 
     grant with other providers of health care services under this 
     Act, and under title V of the Social Security Act, including 
     programs promoting the reduction and elimination of risk of 
     HIV/AIDS for youth.
       ``(2) The applicant will participate in the statewide 
     coordinated statement of need under part B (where it has been 
     initiated by the public health agency responsible for 
     administering grants under part B) and in revisions of such 
     statement.
       ``(3) The applicant will every 2 years submit to the lead 
     State agency under section 2617(b)(4) audits regarding funds 
     expended in accordance with this title and shall include 
     necessary client-level data to complete unmet need 
     calculations and Statewide coordinated statements of need 
     process.
       ``(d) Administration; Application.--A grant may only be 
     awarded to an entity under subsection (a) if an application 
     for the grant is submitted to the Secretary and the 
     application is in such form, is made in such manner, and 
     contains such agreements, assurances, and information as the 
     Secretary determines to be necessary to carry out this 
     section. Such application shall include the following:
       ``(1) Information regarding how the expected expenditures 
     of the grant are related to the planning process for 
     localities funded under part A (including the planning 
     process outlined in section 2602) and for States funded under 
     part B (including the planning process outlined in section 
     2617(b)).
       ``(2) A specification of the expected expenditures and how 
     those expenditures will improve overall patient outcomes, as 
     outlined as part of the State plan (under section 2617(b)) or 
     through additional outcome measures.
       ``(e) Annual Review of Programs; Evaluations.--
       ``(1) Review regarding access to and participation in 
     programs.--With respect to a grant under subsection (a) for 
     an entity for a fiscal year, the Secretary shall, not later 
     than 180 days after the end of the fiscal year, provide for 
     the conduct and completion of a review of the operation 
     during the year of the program carried out under such 
     subsection by the entity. The purpose of such review shall be 
     the development of recommendations, as appropriate, for 
     improvements in the following:
       ``(A) Procedures used by the entity to allocate 
     opportunities and services under subsection (a) among 
     patients of the entity who are women, infants, children, or 
     youth.
       ``(B) Other procedures or policies of the entity regarding 
     the participation of such individuals in such program.
       ``(2) Evaluations.----The Secretary shall, directly or 
     through contracts with public and private entities, provide 
     for evaluations of programs carried out pursuant to 
     subsection (a).
       ``(f) Administrative Expenses.--
       ``(1) Limitation.--A grantee may not use more than 10 
     percent of amounts received under a grant awarded under this 
     section for administrative expenses.
       ``(2) Clinical quality management program.--A grantee under 
     this section shall implement a clinical quality management 
     program to assess the extent to which HIV health services 
     provided to patients under the grant are consistent with the 
     most recent Public Health Service guidelines for the 
     treatment of HIV/AIDS and related opportunistic infection, 
     and as applicable, to develop strategies for ensuring that 
     such services are consistent with the guidelines for 
     improvement in the access to and quality of HIV health 
     services.
       ``(g) Training and Technical Assistance.--From the amounts 
     appropriated under subsection (i) for a fiscal year, the 
     Secretary may use not more than 5 percent to provide, 
     directly or through contracts with public and private 
     entities (which may include grantees under subsection (a)), 
     training and technical assistance to assist applicants and 
     grantees under subsection (a) in complying with the 
     requirements of this section.
       ``(h) Definitions.--In this section:

[[Page 20464]]

       ``(1) Administrative expenses.--The term `administrative 
     expenses' means funds that are to be used by grantees for 
     grant management and monitoring activities, including costs 
     related to any staff or activity unrelated to services or 
     indirect costs.
       ``(2) Indirect costs.--The term `indirect costs' means 
     costs included in a Federally negotiated indirect rate.
       ``(3) Services.--The term `services' means--
       ``(A) services that are provided to clients to meet the 
     goals and objectives of the program under this section, 
     including the provision of professional, diagnostic, and 
     therapeutic services by a primary care provider or a referral 
     to and provision of specialty care; and
       ``(B) services that sustain program activity and contribute 
     to or help improve services under subparagraph (A).
       ``(i) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there are authorized to be 
     appropriated, $71,800,000 for each of the fiscal years 2007 
     through 2011.''.

     SEC. 402. GAO REPORT.

       Not later than 24 months after the date of enactment of 
     this Act, the Comptroller General of the Government 
     Accountability Office shall conduct an evaluation, and submit 
     to Congress a report, concerning the funding provided for 
     under part D of title XXVI of the Public Health Service Act 
     to determine--
       (1) how funds are used to provide the administrative 
     expenses, indirect costs, and services, as defined in section 
     2671(h) of such title, for individuals with HIV/AIDS;
       (2) how funds are used to provide the administrative 
     expenses, indirect costs, and services, as defined in section 
     2671(h) of such title, to family members of women, infants, 
     children, and youth infected with HIV/AIDS;
       (3) how funds are used to provide family-centered care 
     involving outpatient or ambulatory care authorized under 
     section 2671(a) of such title;
       (4) how funds are used to provide additional services 
     authorized under section 2671(b) of such title; and
       (5) how funds are used to help identify HIV-positive 
     pregnant women and their children who are exposed to HIV and 
     connect them with care that can improve their health and 
     prevent perinatal transmission.

                      TITLE V--GENERAL PROVISIONS

     SEC. 501. GENERAL PROVISIONS.

       Part E of title XXVI of the Public Health Service Act (42 
     U.S.C. 300ff-80 et seq.) is amended to read as follows:

                      ``PART E--GENERAL PROVISIONS

     ``SEC. 2681. COORDINATION.

       ``(a) Requirement.--The Secretary shall ensure that the 
     Health Resources and Services Administration, the Centers for 
     Disease Control and Prevention, the Substance Abuse and 
     Mental Health Services Administration, and the Centers for 
     Medicare & Medicaid Services coordinate the planning, 
     funding, and implementation of Federal HIV programs 
     (including all minority AIDS initiatives of the Public Health 
     Service, including under section 2693) to enhance the 
     continuity of care and prevention services for individuals 
     with HIV/AIDS or those at risk of such disease. The Secretary 
     shall consult with other Federal agencies, including the 
     Department of Veterans Affairs, as needed and utilize 
     planning information submitted to such agencies by the States 
     and entities eligible for assistance under this title.
       ``(b) Report.--The Secretary shall biennially prepare and 
     submit to the appropriate committees of the Congress a report 
     concerning the coordination efforts at the Federal, State, 
     and local levels described in this section, including a 
     description of Federal barriers to HIV program integration 
     and a strategy for eliminating such barriers and enhancing 
     the continuity of care and prevention services for 
     individuals with HIV/AIDS or those at risk of such disease.
       ``(c) Integration by State.--As a condition of receipt of 
     funds under this title, a State shall provide assurances to 
     the Secretary that health support services funded under this 
     title will be integrated with other such services, that 
     programs will be coordinated with other available programs 
     (including Medicaid), and that the continuity of care and 
     prevention services of individuals with HIV/AIDS is enhanced.
       ``(d) Integration by Local or Private Entities.--As a 
     condition of receipt of funds under this title, a local 
     government or private nonprofit entity shall provide 
     assurances to the Secretary that services funded under this 
     title will be integrated with other such services, that 
     programs will be coordinated with other available programs 
     (including Medicaid), and that the continuity of care and 
     prevention services of individuals with HIV is enhanced.

     ``SEC. 2682. AUDITS.

       ``(a) In General.--For fiscal year 2009, and each 
     subsequent fiscal year, the Secretary may reduce the amounts 
     of grants under this title to a State or political 
     subdivision of a State for a fiscal year if, with respect to 
     such grants for the second preceding fiscal year, the State 
     or subdivision fails to prepare audits in accordance with the 
     procedures of section 7502 of title 31, United States Code. 
     The Secretary shall annually select representative samples of 
     such audits, prepare summaries of the selected audits, and 
     submit the summaries to the Congress.
       ``(b) Posting on the Internet.--All audits that the 
     Secretary receives from the State lead agency under section 
     2617(b)(4) shall be posted, in their entirety, on the 
     Internet website of the Health Resources and Services 
     Administration.

     ``SEC. 2683. PUBLIC HEALTH EMERGENCY.

       ``(a) In General.--In an emergency area and during an 
     emergency period, the Secretary shall have the authority to 
     waive such requirements of this title to improve the health 
     and safety of those receiving care under this title and the 
     general public, except that the Secretary may not expend more 
     than 5 percent of the funds allocated under this title for 
     sections 2620 and section 2603(b).
       ``(b) Emergency Area and Emergency Period.--In this 
     section:
       ``(1) Emergency area.--The term `emergency area' means a 
     geographic area in which there exists--
       ``(A) an emergency or disaster declared by the President 
     pursuant to the National Emergencies Act or the Robert T. 
     Stafford Disaster Relief and Emergency Assistance Act; or
       ``(B) a public health emergency declared by the Secretary 
     pursuant to section 319.
       ``(2) Emergency period.--The term `emergency period' means 
     the period in which there exists--
       ``(A) an emergency or disaster declared by the President 
     pursuant to the National Emergencies Act or the Robert T. 
     Stafford Disaster Relief and Emergency Assistance Act; or
       ``(B) a public health emergency declared by the Secretary 
     pursuant to section 319.
       ``(c) Unobligated Funds.--If funds under a grant under this 
     section are not expended for an emergency in the fiscal year 
     in which the emergency is declared, such funds shall be 
     returned to the Secretary for reallocation under sections 
     2603(b) and 2620.

     ``SEC. 2684. PROHIBITION ON PROMOTION OF CERTAIN ACTIVITIES.

       ``None of the funds appropriated under this title shall be 
     used to fund AIDS programs, or to develop materials, designed 
     to promote or encourage, directly, intravenous drug use or 
     sexual activity, whether homosexual or heterosexual. Funds 
     authorized under this title may be used to provide medical 
     treatment and support services for individuals with HIV.

     ``SEC. 2685. PRIVACY PROTECTIONS.

       ``(a) In General.--The Secretary shall ensure that any 
     information submitted to, or collected by, the Secretary 
     under this title excludes any personally identifiable 
     information.
       ``(b) Definition.--In this section, the term `personally 
     identifiable information' has the meaning given such term 
     under the regulations promulgated under section 264(c) of the 
     Health Insurance Portability and Accountability Act of 1996.

     ``SEC. 2686. GAO REPORT.

       ``The Comptroller General of the Government Accountability 
     Office shall biennially submit to the appropriate committees 
     of Congress a report that includes a description of Federal, 
     State, and local barriers to HIV program integration, 
     particularly for racial and ethnic minorities, including 
     activities carried out under subpart III of part F, and 
     recommendations for enhancing the continuity of care and the 
     provision of prevention services for individuals with HIV/
     AIDS or those at risk for such disease. Such report shall 
     include a demonstration of the manner in which funds under 
     this subpart are being expended and to what extent the 
     services provided with such funds increase access to 
     prevention and care services for individuals with HIV/AIDS 
     and build stronger community linkages to address HIV 
     prevention and care for racial and ethnic minority 
     communities.

     ``SEC. 2687. DEFINITIONS.

       ``For purposes of this title:
       ``(1) AIDS.--The term `AIDS' means acquired immune 
     deficiency syndrome.
       ``(2) Co-occurring conditions.--The term `co-occurring 
     conditions' means one or more adverse health conditions in an 
     individual with HIV/AIDS, without regard to whether the 
     individual has AIDS and without regard to whether the 
     conditions arise from HIV.
       ``(3) Counseling.--The term `counseling' means such 
     counseling provided by an individual trained to provide such 
     counseling.
       ``(4) Family-centered care.--The term `family-centered 
     care' means the system of services described in this title 
     that is targeted specifically to the special needs of 
     infants, children, women and families. Family-centered care 
     shall be based on a partnership between parents, 
     professionals, and the community designed to ensure an 
     integrated, coordinated, culturally sensitive, and community-
     based continuum of care for children, women, and families 
     with HIV/AIDS.
       ``(5) Families with hiv/aids.--The term `families with HIV/
     AIDS' means families in which one or more members have HIV/
     AIDS.
       ``(6)  HIV.--The term `HIV' means infection with the human 
     immunodeficiency virus.
       ``(7) HIV/AIDS.--
       ``(A) In general.--The term `HIV/AIDS' means HIV, and 
     includes AIDS and any condition arising from AIDS.
       ``(B) Counting of cases.--The term `living cases of HIV/
     AIDS', with respect to the

[[Page 20465]]

     counting of cases in a geographic area during a period of 
     time, means the sum of--
       ``(i) the number of living non-AIDS cases of HIV in the 
     area; and
       ``(ii) the number of living cases of AIDS in the area.
       ``(C) Non-aids cases.--The term `non-AIDS', with respect to 
     a case of HIV, means that the individual involved has HIV but 
     does not have AIDS.
       ``(8) Human immunodeficiency virus.--The term `human 
     immunodeficiency virus' means the etiologic agent for AIDS.
       ``(9) Official poverty line.--The term `official poverty 
     line' means the poverty line established by the Director of 
     the Office of Management and Budget and revised by the 
     Secretary in accordance with section 673(2) of the Omnibus 
     Budget Reconciliation Act of 1981.
       ``(10) Person.--The term `person' includes one or more 
     individuals, governments (including the Federal Government 
     and the governments of the States), governmental agencies, 
     political subdivisions, labor unions, partnerships, 
     associations, corporations, legal representatives, mutual 
     companies, joint-stock companies, trusts, unincorporated 
     organizations, receivers, trustees, and trustees in cases 
     under title 11, United States Code.
       ``(11) State.--
       ``(A) In general.--The term `State' means each of the 50 
     States, the District of Columbia, and each of the 
     territories.
       ``(B) Territories.--The term `territory' means each of 
     American Samoa, Guam, the Commonwealth of Puerto Rico, the 
     Commonwealth of the Northern Mariana Islands, the Virgin 
     Islands, the Republic of the Marshall Islands, the Federated 
     States of Micronesia, and Palau.
       ``(12) Youth with hiv.--The term `youth with HIV' means 
     individuals who are 13 through 24 years old and who have HIV/
     AIDS.''.

                  TITLE VI--DEMONSTRATION AND TRAINING

     SEC. 601. DEMONSTRATION AND TRAINING.

       Subpart I of part F of title XXVI of the Public Health 
     Service Act (42 U.S.C. 300ff-101 et seq.) is amended to read 
     as follows:

         ``Subpart I--Special Projects of National Significance

     ``SEC. 2691. SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE.

       ``(a) In General.--Of the amount appropriated under each of 
     parts A, B, C, and D for each fiscal year, the Secretary 
     shall use the greater of $20,000,000 or an amount equal to 3 
     percent of such amount appropriated under each such part, but 
     not to exceed $25,000,000, to administer special projects of 
     national significance to--
       ``(1) quickly respond to emerging needs of individuals 
     receiving assistance under this title; and
       ``(2) to fund special programs to develop a standard 
     electronic client information data system to improve the 
     ability of grantees under this title to report client-level 
     data to the Secretary.
       ``(b) Grants.--The Secretary shall award grants under 
     subsection (a) to entities eligible for funding under parts 
     A, B, C, and D based on--
       ``(1) whether the funding will promote obtaining client 
     level data as it relates to the creation of a severity of 
     need index under section 2618(a)(2)(E), including funds to 
     facilitate the purchase and enhance the utilization of 
     qualified health information technology systems;
       ``(2) demonstrated ability to create and maintain a 
     qualified health information technology system;
       ``(3) the potential replicability of the proposed activity 
     in other similar localities or nationally;
       ``(4) the demonstrated reliability of the proposed 
     qualified health information technology system across a 
     variety of providers, geographic regions, and clients; and
       ``(5) the demonstrated ability to maintain a safe and 
     secure qualified health information system; or
       ``(6) newly emerging needs of individuals receiving 
     assistance under this title.
       ``(c) Coordination.--The Secretary may not make a grant 
     under this section unless the applicant submits evidence that 
     the proposed program is consistent with the statewide 
     coordinated statement of need, and the applicant agrees to 
     participate in the ongoing revision process of such statement 
     of need.
       ``(d) Privacy Protection.--The Secretary may not make a 
     grant under this section for the development of a qualified 
     health information technology system unless the applicant 
     provides assurances to the Secretary that the system will, at 
     a minimum, comply with the privacy regulations promulgated 
     under section 264(c) of the Health Insurance Portability and 
     Accountability Act of 1996.
       ``(e) Replication.--The Secretary shall make information 
     concerning successful models or programs developed under this 
     part available to grantees under this title for the purpose 
     of coordination, replication, and integration. To facilitate 
     efforts under this subsection, the Secretary may provide for 
     peer-based technical assistance for grantees funded under 
     this part.''.

     SEC. 602. AIDS EDUCATION AND TRAINING CENTERS.

       (a) Amendments Regarding Schools and Centers.--Section 
     2692(a)(2) of the Public Health Service Act (42 U.S.C. 300ff-
     111(a)(2)) is amended--
       (1) in subparagraph (A)--
       (A) by inserting ``and Native Americans'' after ``minority 
     individuals''; and
       (B) by striking ``and'' at the end;
       (2) in subparagraph (B), by striking the period and 
     inserting ``; and''; and
       (3) by adding at the end the following:
       ``(C) train or result in the training of health 
     professionals and allied health professionals to provide 
     treatment for hepatitis B or C co-infected individuals.''.
       (b) Authorizations of Appropriations for Schools, Centers, 
     and Dental Programs.--Section 2692(c) of the Public Health 
     Service Act (42 U.S.C. 300ff-111(c)) is amended to read as 
     follows:
       ``(c) Authorization of Appropriations.--
       ``(1) Schools; centers.--For the purpose of awarding grants 
     under subsection (a), there is authorized to be appropriated 
     $34,700,000 for each of the fiscal years 2007 through 2011.
       ``(2) Dental schools.--For the purpose of awarding grants 
     under subsection (b), there is authorized to be appropriated 
     $13,000,000 for each of the fiscal years 2007 through 
     2011.''.

     SEC. 603. CODIFICATION OF MINORITY AIDS INITIATIVE.

       Part F of title XXVI of the Public Health Service Act (42 
     U.S.C. 300ff-101 et seq.) is amended by adding at the end the 
     following:

                ``Subpart III--Minority AIDS Initiative

     ``SEC. 2693. MINORITY AIDS INITIATIVE.

       ``(a) In General.--For the purpose of carrying out 
     activities under this section to evaluate and address the 
     disproportionate impact of HIV/AIDS on, and the disparities 
     in access, treatment, care, and outcomes for, racial and 
     ethnic minorities (including African Americans, Alaska 
     Natives, Latinos, American Indians, Asian Americans, Native 
     Hawaiians, and Pacific Islanders), there are authorized to be 
     appropriated $131,200,000 for fiscal year 2007, $135,100,000 
     for fiscal year 2008, $139,100,000 for fiscal year 2009, 
     $143,200,000 for fiscal year 2010, and $147,500,000 for 
     fiscal year 2011.
       ``(b) Certain Activities.--
       ``(1) In general.--In carrying out the purpose described in 
     subsection (a), the Secretary shall provide for--
       ``(A) emergency assistance under part A;
       ``(B) care grants under part B;
       ``(C) early intervention services under part C;
       ``(D) services through projects for HIV-related care under 
     part D; and
       ``(E) activities through education and training centers 
     under section 2692.
       ``(2) Allocations among activities.--Activities under 
     paragraph (1) shall be carried out by the Secretary in 
     accordance with the following:
       ``(A) For competitive, supplemental grants to improve HIV-
     related health outcomes to reduce existing racial and ethnic 
     health disparities, the Secretary shall, of the amount 
     appropriated under subsection (a) for a fiscal year, reserve 
     the following, as applicable:
       ``(i) For fiscal year 2007, $43,800,000.
       ``(ii) For fiscal year 2008, $45,400,000.
       ``(iii) For fiscal year 2009, $47,100,000.
       ``(iv) For fiscal year 2010, $48,800,000.
       ``(v) For fiscal year 2011, $50,700,000.
       ``(B) For competitive grants used for supplemental support 
     education and outreach services to increase the number of 
     eligible racial and ethnic minorities who have access to 
     treatment through the program under section 2616 for 
     therapeutics, the Secretary shall, of the amount appropriated 
     for a fiscal year under subsection (a), reserve the 
     following, as applicable:
       ``(i) For fiscal year 2007, $7,000,000.
       ``(ii) For fiscal year 2008, $7,300,000.
       ``(iii) For fiscal year 2009, $7,500,000.
       ``(iv) For fiscal year 2010, $7,800,000.
       ``(v) For fiscal year 2011, $8,100,000.
       ``(C) For planning grants, capacity-building grants, and 
     services grants to health care providers who have a history 
     of providing culturally and linguistically appropriate care 
     and services to racial and ethnic minorities, the Secretary 
     shall, of the amount appropriated for a fiscal year under 
     subsection (a), reserve the following, as applicable:
       ``(i) For fiscal year 2007, $53,400,000.
       ``(ii) For fiscal year 2008, $55,400,000.
       ``(iii) For fiscal year 2009, $57,400,000.
       ``(iv) For fiscal year 2010, $59,500,000.
       ``(v) For fiscal year 2011, $61,800,000.
       ``(D) For eliminating racial and ethnic disparities in the 
     delivery of comprehensive, culturally and linguistically 
     appropriate care services for HIV disease for women, infants, 
     children, and youth, the Secretary shall, of the amount 
     appropriated under subsection (a), reserve $18,500,000 for 
     each of the fiscal years 2007 through 2011.
       ``(E) For increasing the training capacity of centers to 
     expand the number of health care professionals with treatment 
     expertise and knowledge about the most appropriate standards 
     of HIV disease-related treatments and medical care for racial 
     and ethnic minority adults, adolescents, and children with 
     HIV disease, the Secretary shall, of the amount appropriated 
     under subsection (a), reserve $8,500,000 for each of the 
     fiscal years 2007 through 2011.

[[Page 20466]]

       ``(c) Consistency With Prior Program.--With respect to the 
     purpose described in subsection (a), the Secretary shall 
     carry out this section consistent with the activities carried 
     out under this title by the Secretary pursuant to the 
     Departments of Labor, Health and Human Services, and 
     Education, and Related Agencies Appropriations Act, 2002 
     (Public Law 107-116).''.

                  TITLE VII--MISCELLANEOUS PROVISIONS

     SEC. 701. HEPATITIS; USE OF FUNDS.

       Section 2667 of the Public Health Service Act (42 U.S.C. 
     300ff-67) is amended--
       (1) in paragraph (2), by striking ``and'' at the end;
       (2) in paragraph (3), by striking the period and inserting 
     ``; and''; and
       (3) by adding at the end the following:
       ``(4) shall provide information on the transmission and 
     prevention of hepatitis A, B, and C, including education 
     about the availability of hepatitis A and B vaccines and 
     assisting patients in identifying vaccination sites.''.

     SEC. 702. CERTAIN REFERENCES.

       Title XXVI of the Public Health Service Act (42 U.S.C. 
     300ff et seq.) is amended--
       (1) by striking ``acquired immune deficiency syndrome'' 
     each place such term appears, other than in section 2687(1) 
     (as added by section 501 of this Act), and inserting 
     ``AIDS'';
       (2) by striking ``such syndrome'' and inserting ``AIDS''; 
     and
       (3) by striking ``HIV disease'' each place such term 
     appears and inserting ``HIV/AIDS''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Georgia (Mr. Deal) and the gentleman from New Jersey (Mr. Pallone) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Georgia.


                             General Leave

  Mr. DEAL of Georgia. Mr. Speaker, I ask unanimous consent that all 
Members may have 5 legislative days in which to revise and extend their 
remarks on this legislation and to insert extraneous material on the 
bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Georgia?
  There was no objection.
  Mr. DEAL of Georgia. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I rise today in strong support of H.R. 6143, the Ryan 
White HIV/AIDS Treatment Modernization Act of 2006, because I believe 
that we must reform the unacceptable status quo for the benefit of 
those suffering from HIV/AIDS across our great Nation.
  As my colleagues are aware, the Ryan White CARE Act was first 
authorized in 1990 and was reauthorized in 1996 and 2000. And although 
the legislative authority expired on September 30, 2005, the program 
continues to operate at its current funding level.
  The outcomes and treatments for HIV and AIDS have changed over the 
years, and so have the needs of those who suffer from the disease. For 
example, persons with HIV now live longer due to advances in drug 
therapies.
  However, many patients are on waiting lists for these life-saving 
drugs, because Ryan White funds are being spent on nonmedical services. 
Those include services not covered for Medicare or Medicaid 
beneficiaries, including buddy and companion services, dog walking, 
therapeutic touching, and housing assistance.
  Dog walking? Therapeutic touching? Is this what the Federal 
Government really wants to pay for? The Ryan White CARE Act program is 
designed to provide needed medical services to people suffering from 
HIV/AIDS. If we do not pass this bill, the status quo will remain.
  The AIDS Drug Assistance Program, ADAP, provides needed life-saving 
therapies to those suffering from HIV/AIDS. These are crucial 
medications that extend and prolong life.
  Next year, funds to supplement States' ADAP spending will be used for 
hold-harmless payments based on an old, inaccurate case count. Patients 
will not receive needed drug therapies if the status quo remains. 
Currently, there is a 50 percent difference in funding for AIDS cases 
for some areas of the country over other areas due to outdated 
formulas.
  Some States cannot find enough doctors to write prescriptions for 
needed medications, while others are paying for buddy and companion 
services. If we do not pass this legislation, the status quo will 
remain.
  Mr. Speaker, the status quo to me is unacceptable, and I think it is 
unacceptable to the taxpayers, and it is unacceptable to those 
suffering from AIDS/HIV.
  Mr. Speaker, I urge my colleagues to support this needed and timely 
legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield myself 3 minutes.
  Mr. Speaker, it is with great regret that I rise in opposition to 
this bill. Unlike previous reauthorizations of the Ryan White CARE Act, 
I believe the legislation before us has the potential to do great harm 
to systems of care around the country and place HIV/AIDS patients at 
risk.
  In my home State of New Jersey, for example, we have tremendous need 
for CARE Act dollars. We have the highest proportion of cumulative AIDS 
cases in women. We rank third in cumulative pediatric AIDS cases, and 
fifth in overall cumulative AIDS cases. In the early days of this 
epidemic when the Federal Government refused to help, New Jersey 
stepped forward and did the right thing.
  Ever since then, we have remained at the forefront of this battle 
working hard to provide the medical and support services HIV/AIDS 
patients need to live longer.
  But that will all change if this bill is enacted. This bill will 
punish States like New Jersey for keeping people alive and preventing 
new infections. It sets up a very perverse disincentive. It says to 
States: you will be penalized for doing a good job. This is not the 
message that Washington should be sending back home.
  Mr. Speaker, there are a number of reasons why this bill is flawed. 
The most obvious is that it is woefully underfunded. As a result, it 
sets up a vicious system of winners and losers. This bill pits AIDS 
against HIV, urban centers against rural communities. This is not how 
you treat a public health emergency.
  If Republicans would stop draining the Treasury to help pay for the 
tax cuts, we would have the resources necessary to adequately address 
this epidemic. Ultimately this bill is flawed, Mr. Speaker. It has no 
business being considered in the waning days of the session on this 
Suspension Calendar.
  Mr. Speaker, it needs to be fixed so that every State has the 
resources to treat their HIV/AIDS patients. I urge my colleagues to 
oppose this bill. Instead, let's pass a temporary reauthorization that 
holds every State harmless so that we can work out these problems.
  Mr. Speaker, I reserve the balance of my time.
  Mr. DEAL of Georgia. Mr. Speaker, I yield 4 minutes to the 
gentlewoman from California (Mrs. Bono), the original sponsor of this 
legislation.
  Mrs. BONO. Mr. Speaker, I rise today in strong support of the Ryan 
White HIV/AIDS Treatment Modernization Act. Its consideration on the 
floor today is testament to the bipartisan nature of this legislation.
  HIV/AIDS is a disease that has virtually touched all of us in all 
parts of our great Nation. Since its inception, the purpose of the Ryan 
White CARE Act has been to provide care.
  As we discuss this specifics of this legislation, and the more 
technical aspects of the funding formulas, it is my hope that each of 
us will bear in mind the true purpose of this legislation. It is 
critical that we recognize the significant steps that have been made 
towards ensuring that the funding we are providing here today is going 
to real people to meet very real and very imminent needs.

                              {time}  1430

  In bringing together systems of care from across the Nation, 
significant compromises have been made, and I assure you that they have 
been made in the interest of providing care to the individuals who need 
it the most. Every attempt has been made to ensure that funds are 
directed to areas of greatest need and are balanced by provisions that 
limit the loss of funds for jurisdictions.
  I believe that none of us want to reduce funding for HIV services in 
any

[[Page 20467]]

jurisdictions, but I ask you to consider carefully the existing 
disparities in funding and services, to bear in mind our solemn duty to 
serve people with HIV regardless of where they live and to support the 
effort of the Modernization Act to address those disparities.
  In California's 45th district, I have had the opportunity to work 
closely with an exceptional provider of this care, the Desert AIDS 
Project. It has been my privilege to see firsthand what caring and 
dedicated people do with the funds and framework that have been 
provided in the Ryan White CARE Act. Their input throughout this 
process has been invaluable to me, and their work has been and 
continues to be inspiring. I would like to express my personal thanks 
to the great people of the Desert AIDS Project.
  I would also like to express my deep appreciation to Chairman Barton, 
Chairman Deal and Ranking Member Dingell for bringing this bill to the 
floor today.
  This reauthorization has been the product of bipartisan and bicameral 
efforts. I would like to thank the committee staff who have dedicated 
so much time to this effort from both sides of the Capitol and from 
both sides of the aisle: Melissa Bartlett, John Ford, Shana Christrup 
and Connie Garner. And, finally, I would like to thank my personal 
staff, both past, Katherine Martin, and present, Taryn Nader, for their 
hard work and tireless efforts on behalf of the Ryan White CARE Act.
  The goal of each Member of this body is to serve their constituencies 
and all citizens of this great country by passing legislation that 
meets the needs of our citizens. The CARE Act has for 16 years been a 
cornerstone of the care, treatment and support services necessary for 
the lives of people living with HIV and AIDS. It is vitally important 
to maintain its support and modernize its approach to ensure it 
continues to sustain the lives of people with HIV and AIDS.
  I ask my colleagues for their support, Mr. Speaker.
  Mr. PALLONE. Mr. Speaker, I yield 4 minutes to the gentleman from 
California (Mr. Waxman), who has been a leader on this Ryan White CARE 
Act from the very beginning.
  Mr. WAXMAN. Mr. Speaker, I rise in very reluctant opposition to this 
Ryan White HIV/AIDS Treatment Modernization Act of 2006.
  I was the original sponsor of the legislation, and I have been a 
long-time supporter of it, but I think we find ourselves in a tragic 
situation today because the basis of the problem is that the population 
of those needing services has grown, but the funds for the Ryan White 
program have not grown with it. This program is chronically 
underfunded.
  Well, that means if we want to give to some people who are very 
deserving, we are going to have to take it from others who are very 
deserving. This should not be the choice of the body in Congress today.
  I recognize that a failure to pass the legislation could put many 
States, like my own, that have been collecting HIV data by code, at a 
severe risk of a loss of funding. Obviously, this is a situation in 
which we wish we would not find ourselves in, but if we adopt this bill 
we are agreeing to a long-term system that does not treat fairly States 
which must now begin to implement a whole new system for finding and 
reporting persons with HIV.
  The bill favors States and cities that collected HIV data by name 
over those that collected it by code; and, as a result, many areas of 
the country will see drastic losses of funding. This is unfair.
  Large and diverse code-based States, like California, would have to 
start from scratch, converting their approximately 40,000 code-based 
cases of HIV to names, and under California law, these cases cannot 
simply be retallied under a new names-based system. The State would 
have to contact 40,000 individuals. I do not think California will be 
able to get all of those individuals entered into the names-based 
system in 3 years.
  So I cannot support legislation that would take critical dollars away 
from California simply because its data system is incomplete. We will 
have the same number of persons with HIV needing services. They should 
not lose needed services because of an unrealistic data requirement.
  I wish I could support this bill. I would support it if this problem 
could be addressed, and I am hopeful that when this bill gets to the 
Senate and there are further deliberations we can get a better bill. I 
do not want to see no bill pass, particularly with the threat that we 
are hearing from the administration that they are going to penalize the 
code-based States, but I do not want to vote for a bill that I do not 
think is a good enough bill.
  The Ryan White program has had a long history of broad bipartisan 
support. It did not pit interests of one area of the country against 
another. It did not ask cities and States to give up critical funds to 
treat people in their areas. Ultimately, we must find the will to 
direct the necessary dollars to this problem. The people who continue 
to suffer from this epidemic deserve no less.
  Mr. Speaker, I have to be reluctant and vote ``no'' and hope that we 
can get a better bill when this legislation passes the House and there 
are further deliberations with the Senate.
  Mr. BARTON of Texas. Mr. Speaker, I ask unanimous consent that I be 
given control of the time on the majority side.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. BARTON of Texas. Mr. Speaker, may I ask how much time remains?
  The SPEAKER pro tempore. The gentleman from Texas (Mr. Barton) has 
14\1/2\ minutes remaining, and the gentleman from New Jersey (Mr. 
Pallone) has 14 minutes remaining.
  Mr. BARTON of Texas. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I rise in support of H.R. 6143, the Ryan White HIV/AIDS 
Treatment Modernization Act of 2006. This legislation was introduced by 
Congresswoman Bono. It is the product of a year of bipartisan, 
bicameral negotiations. The bill reauthorizes and reforms the Ryan 
White program, the Federal Government's largest discretionary grant 
program specifically designed for people with HIV/AIDS.
  We know that HIV/AIDS disproportionately affects people in poverty 
and racial/ethnic populations who are underserved by health care and 
prevention systems. We know that the most likely users of Ryan White 
services are persons with no or limited sources of health care. We know 
that Ryan White services keeps these people out of hospitals, increases 
their access to health care and improves their quality of life.
  Here is what we also know about the current Ryan White program. We 
know that due to outdated, hold-harmless and double-counting provisions 
in the current law persons are not treated similarly across this 
country. We know that, under the current formula, there is reportedly a 
50 percent increase in funding per AIDS case for some areas of the 
country over other areas of the country who get no increase or little 
increase at all. We know that sometimes this huge inequity occurs 
within the same State. We know that one city in particular is greatly 
advantaged by an outdated, hold-harmless formula, one that may allow 
even for deceased persons, someone who is no longer living, counted for 
current funding purposes. I do not think anyone would think that is 
right. In fact, I would say that is not right.
  The Ryan White program was established to be the payor of last resort 
for needed medical services for those suffering from HIV/AIDS. Then and 
now, that is a noble cause and one worth supporting. However, we know 
that in many States, including my own State of Texas, Ryan White 
dollars, Federal taxpayer dollars, are being used for nonhealth care 
services. What kind of services? For example, buddy/companion services, 
child care services, housing, transportation and many other types of 
services similar to these are being provided with Ryan White dollars. 
While some of these services may, arguably, be necessary to get people 
to health care and keep people in

[[Page 20468]]

health care, others are misuses of Ryan White dollars under the current 
formula and need to be fixed.
  The use of Ryan White funds for such services should be put into 
check. We should be asking the question, why are there waiting lists in 
some parts of the country to get lifesaving drugs? And why in some 
parts of the country are there no physicians to even write 
prescriptions for these lifesaving drugs? Again, this is just not 
right. It is not fair.
  The bill before us would begin to right those wrongs. The bill before 
us would begin to treat people across the country in a fair and 
equitable fashion so that, no matter where you live, if you are 
eligible for Ryan White assistance, you will get access to health care, 
you will get access to treatment, you will get access to drugs.
  This bill requires cities, States and providers to start making the 
right decisions when it comes to how to spend their Ryan White dollars 
by requiring that they spend at least 75 percent on core medical 
services. I repeat, they must spend at least 75 percent on core medical 
services. HIV/AIDS is, first and foremost, a medical condition and 
providing medical care should be the primary focus of the Federal bill.
  I know that the bill is not perfect. I know that there have been 
significant compromises made by all parties at the table. I know that 
had any one party decided to write a reauthorization bill the bill 
would look different than it does today. This bill, though, reflects 
over a year of intense negotiations by all of the stakeholders. It 
reflects the input of many stakeholder groups and the Bush 
administration. The bill advances important consensus policy reforms.
  The bill is also coming to this floor at a critical time for the Ryan 
White program. In just 3 days, again, 3 days from today, current law 
dictates that many areas of this country, including several large 
States, will not be able to include their HIV case counts to receive 
the appropriate Federal funding to provide services to persons in their 
States.
  What does this mean? This means that thousands of HIV persons may 
have their health care needs put in jeopardy. This means that, under 
current law, the drug grant program will be reduced by 3 percent to pay 
for any existing hold harmless. So, at a time when there are people on 
waiting lists for drugs in some parts of the country, access to drugs 
in other parts of the country will be hindered, be reduced. These drug 
dollars will come up short. According to the Department of Health and 
Human Services, there will be about a $40 million shortfall. Those are 
real dollars that otherwise would go to help real people. I cannot 
underscore the urgency of passing this bill today to prevent these 
cuts.
  I want to commend Congresswoman Bono for her leadership in preventing 
these losses. I also want to thank Congressman Dingell, Senator Kennedy 
and Senator Enzi in the other body for their hard work on this 
consensus bill to reauthorize the program.
  At the staff level, I want to thank John Ford on the minority staff 
and Melissa Bartlett on the majority staff for their hard work in 
dedicating themselves during the last several months and the last year 
to produce the legislation that is before us today.
  Finally, I want to thank the Legislative Counsel's office and, in 
particular, Pete Goodloe. He has worked very, very hard on this.
  It is critical that we act today in a positive fashion so that we can 
prevent the cuts that go into effect 3 days from today.
  The bill before us passed the Energy and Commerce Committee on a 38-
10 bipartisan vote last week. If it passes this body under suspension, 
it will go to the other body, and we will work very hard to get it 
passed over there in the next 2 days. Because it is on suspension, it 
takes a two-thirds vote, which, if everyone is present and voting, we 
will need 291 Members to vote in favor of reauthorization of the Ryan 
White HIV/AIDS Act. I hope we get that vote later this afternoon.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield 3 minutes to the gentleman from New 
York (Mr. Engel).
  Mr. ENGEL. Mr. Speaker, I thank my friend from New Jersey for 
yielding to me; and, first of all, Mr. Speaker, I want to express my 
extreme displeasure that this bill comes here today on consent 
calendar, a bill with more than $2 billion in this bill and we have 40 
minutes to debate it. This is not a bill that should be under a 
suspension calendar. This is a bill that should have full and open 
debate among the Congress with not a 40-minute time limitation.
  This is not a consensus bill. This is a contentious bill, and many of 
us are very, very upset. We are upset about the bill, and we are upset 
at the manner that this leadership brings this bill to the House floor.
  This bill will destabilize established systems and care and will have 
a devastating effect on the ability of high prevalent communities to 
address need; and, unfortunately, as home to 17 percent, which is one-
sixth of the Nation's AIDS population, New York is just so upset that 
this bill has come out the way it has. This is profoundly important to 
our State. That is why all 29 Members of the New York delegation, 
Democrats and Republicans alike, have signed a letter opposing this 
bill and pledging to vote against the bill.
  New York remains the epicenter of the HIV/AIDS crisis, leading the 
Nation in both the number of persons living with HIV/AIDS and number of 
new cases of HIV/AIDS each year.
  But what does this bill do? It has been estimated that New York State 
stands to lose more than $78 million in the first 4 years of the 
reauthorization. New York City will likely lose $17 million in the 
first year alone.

                              {time}  1445

  This bill will result in deep cuts in medications and services for 
people living with HIV/AIDS throughout the State.
  It reminds me of homeland security. Sometimes we need to use a little 
common sense. Homeland security, everyone knows, unfortunately, that 
New York City remains the number one terrorist target and Washington 
number two. So what did we have when we had the Department of Homeland 
Security come up with its budget? They cut New York City by 30 percent 
and cut Washington by 30 percent. The two biggest terrorist threats. 
That made no sense at all.
  What happens here? New York City remains the epicenter of the AIDS 
epidemic, and what does this bill do? It cuts $78 million for New York 
and $17 million for New York City. It is shameful and disgraceful.
  And despite what some may say, the HIV/AIDS epidemic has not shifted. 
It has expanded. One-half of all people living with AIDS reside in five 
States: New York, New Jersey, Florida, Texas, and California. Three of 
these States, New York, New Jersey and Florida, will face devastating 
losses under this reauthorization.
  There is no question that other States have mounting epidemics and 
they are absolutely entitled and deserving of more funding. A good Ryan 
White bill would have ensured that every State had enough money to meet 
their needs; that every State would be held harmless; that every State 
would not be a winner or a loser, but that every State would have the 
resources needed to combat the scourge of AIDS.
  I offered amendments in committee to increase funding for the bill 
with Mr. Towns, Ms. Eshoo, and Mrs. Capps. It failed on essentially a 
party-line vote. So I strongly urge my colleagues to vote against this 
bill.
  Where are our spending priorities? We continue to pass irresponsible 
tax cuts in a time of war, and yet shortchange cities and states who 
are just trying to provide lifesaving services. We're truly talking 
about life and death here, and it is shameful that we are pitting 
states against each other for scarce funding.
  Compounding the funding problem is that a proposed Severity of Need 
Index, expected to be implemented in this reauthorization, may consider 
state and local resources in determining how much federal funding to 
grant to states.
  This is not the right message to send to NY that has more HIV/AIDS 
cases than any other

[[Page 20469]]

state in the nation and spends more of its state dollars on care for 
HIV/AIDS patients than any other state in the nation. We have always 
viewed caring for our HIV/AIDS patients as a partnership between the 
local, state and federal governments. The Severity of Need Index is a 
powerful disincentive for states and local areas to take action.
  It is with great sadness that I will vote against this bill today. 
But NY needs to make sure that we can keep helping the nearly 110,000 
people living in our state with HIV/AIDS. We need to make sure we can 
keep providing life saving drugs and healthcare services which are 
preventing the transmission of HIV, preventing the progression from HIV 
to AIDS and ultimately keeping people from dying. This bill compromises 
our ability to do this.
  This is why Mayor Bloomberg opposes this bill, this is why Gov. 
Pataki opposes this bill and this is why I must as well. Our nation 
deserves better than the underlying bill before us and it is a disgrace 
that this is all it will get.
  Mr. BARTON of Texas. Mr. Speaker, I yield 1 minute to the gentlewoman 
from Florida (Ms. Ros-Lehtinen).
  Ms. ROS-LEHTINEN. Mr. Speaker, I thank the chairman for the time.
  Mr. Speaker, this bill seeks to offer services by primary care 
providers for the uninsured and less fortunate individuals. We have to 
work together to improve the quality and the availability of care for 
persons living with HIV/AIDS.
  In my congressional district of Miami-Dade County, we had the second 
highest rate of AIDS, major cases of AIDS of all the cities in 2004. 
And the number of people suffering with HIV/AIDS has reached epidemic 
proportions, especially within my district with minority communities. 
There are over 12,000 people living with AIDS in Miami-Dade County and 
almost 10,000 living with HIV.
  We have got to remain vigilant in our efforts to provide for and 
protect the HIV infected, affected, and at-risk individuals living in 
this country, especially through prevention and education; and this 
bill seeks to do that.
  Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentleman from New 
York (Mr. Towns).
  Mr. TOWNS. Mr. Speaker, I thank the gentleman for yielding. This 
bill, maybe if we changed the name of it, maybe it might help some 
folks, because this is called the winner-loser bill. Calling it Ryan 
White is a misnomer. I think that is a shame, that we would move 
legislation without the opportunity to amend it and to try to make it 
better and to be able to deal with the States that are getting hurt.
  We act as if we are not talking about human beings. New York State 
would lose $17 million. And, of course, the Governor of the State has 
said he is against the bill and the mayor of the city indicated that he 
is against the bill. And every Member of the New York State delegation, 
New York City delegation has indicated that they are actually against 
this legislation.
  I don't understand why we have to rush this and put this kind of bill 
on suspension. It seems to me that this is a bill that we would bring 
up and give people an opportunity to amend it and make it as strong as 
possible, because we are talking about lives. So the reauthorization 
does not have to be brought up this kind of way.
  And let us be candid, Brooklyn itself would lose approximately $3 
million, and that is the epicenter of the disease. So I don't 
understand why we can't take our time and provide help for the people 
that truly need help. Of course I am against this bill in every way, 
and I am hoping that my colleagues understand that we can do a much 
better job and that we need to do a much better job. What we have to do 
now is to defeat it and then let us go back and come up with a bill 
that is going to improve the quality of life for people that need it. I 
hope the Members of this body will understand that.
  These States that are losing, and there are quite a few of them, I 
think that we would want to do something and do it right on behalf of 
the people. So I urge my colleagues to vote ``no'' on this bill.
  Mr. BARTON of Texas. Mr. Speaker, I yield 2 minutes to the 
gentlewoman from New York (Mrs. Kelly).
  Mrs. KELLY. Mr. Speaker, I rise in strong support of the Ryan White 
CARE Act and the great care that it offers for those suffering from 
HIV/AIDS. But today I reluctantly rise in opposition to this 
legislation because it contains flawed provisions with harsh and 
negative effects for New York's Hudson Valley and New York State.
  I represent Dutchess County, New York, and the eligible metropolitan 
area in that county. If this bill is passed, Dutchess County would lose 
up to 5 percent the first year, and then incrementally more in the 
second and third year. And by the fourth year, all funds for title I 
would be eliminated for Dutchess County.
  Title I money goes for support and services for people living with 
HIV/AIDS. The patients benefiting from these services simply will not 
get their needed medication because the program won't exist. If the 
funds to Dutchess County disappear, there is absolutely nowhere near 
where the HIV/AIDS patients would be able to go for support, services, 
and medication because the entire State is suffering from the cuts for 
New York that this bill calls for.
  This means over 1,600 people in Dutchess County alone will lose out 
with the passage of the Ryan White CARE Act in its current form. This 
is unacceptable, and that is why I reluctantly ask that you vote 
against H.R. 6143 at this time. This legislation should be brought up 
under regular order so that amendments can be offered.
  And while I strongly support the Ryan White Act, the HIV/AIDS problem 
is a problem that requires resources to fight. While we recognize the 
need to direct attention to those communities where this is an emerging 
problem, we must not do so at the cost of the places that need it the 
most. People in my district and the people of New York need these 
lifesaving funds. Please don't take away from them. Vote against H.R. 
6143.
  Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
California (Ms. Solis).
  Ms. SOLIS. Mr. Speaker, I thank the gentleman.
  Mr. Speaker, I am not reluctant to vote against this bill. I voted 
against it in committee because it is not the right measure we should 
be approving today. In fact, I supported some of our alternative 
amendments that were presented by folks on our side of the aisle.
  For my community, this is devastating. We see an increase in 
communities like East Los Angeles, the hub of the Hispanic community in 
the San Gabriel Valley, that fought over 20 years to combat this 
disease, yet it continues to be on the rise. Yet you want to take away 
very important funding and reappropriate it to other parts of the 
country.
  We need to expand the pie. We need to make sure people are covered 
everywhere. And I am glad to hear from my colleagues that while we know 
that this is not a good solution, but we are really working toward a 
deadline of October 1, we should hold off, make some rational 
decisions, and when we come back in November do the right thing for 
those afflicted by this disease.
  I am very concerned, because a large number of Latinas, almost 20 to 
25 percent, are now faced with this disease, and it is through 
heterosexual relationships. We have yet to understand what the cultural 
dichotomies are that exist in our communities. We have to understand 
that, get information tools out there, a campaign to combat this 
disease, and put all the resources that are necessary there.
  I am glad that we were able to get some semblance of these concepts 
in the bill, but it is still not good enough. Places like Los Angeles 
and San Francisco and other epicenters that we heard of in New York and 
Miami, they are affected. Our communities need this funding.
  So I just want to say to my colleagues that don't know much about 
this, because it is on suspension, take a very close look at what is 
going on in your district. All of my groups, the minority groups that I 
represent, are saying that they also are urging us to vote ``no'' on 
this bill.
  The reauthorization of the Ryan White CARE Act has enormous 
implications for people living with HIV and AIDS, and the communities 
providing related health services.

[[Page 20470]]

  The communities I represent in East Los Angeles and the San Gabriel 
Valley have fought this disease since its onset over 20 years ago.
  Los Angeles is an epicenter of the HIV and AIDS epidemic, with 
between 50,000 and 60,000 persons living with HIV/AIDS.
  As the epidemic grows, communities of color are disproportionately at 
risk.
  Although only 14 percent of the U.S. population, Latinos constitute 
almost 20 percent of the AIDS cases diagnosed since the start of the 
epidemic.
  I am proud of the work that has been accomplished to codify the 
Minority AIDS Initiative in this reauthorization, a priority of the 
TriCaucus.
  I am pleased that the committee agreed to report language recognizing 
the importance of language services to persons with limited English 
proficiency at risk of and living with HIV and AIDS.
  However, I cannot support this legislation.
  We are being pushed to vote on this legislation because of an 
arbitrary October 1 deadline.
  We could move to extend this deadline and create better, sounder 
policy, as my good friend Mr. Pallone has suggested, but instead we are 
being pushed to vote on legislation that risks too much for the health 
of too many.
  This bill considers language services a support service, when in 
reality, for many racial and ethnic minorities, language services are 
necessary to ensure proper HIV/AIDS related health care.
  This bill also bases future funding levels on questionable runs and 
conflicting data.
  I believe that, while we need to address the increasing incidence of 
HIV and AIDS in the south and rural areas, we must do this without 
risking those communities such as mine which have historically had 
large populations and which continue to struggle.
  The position we are in today is not enviable, but we have the 
opportunity to work through the needs of our States and communities by 
rejecting the arbitrary deadlines.
  I am rejecting this risky bill and encouraging my colleagues to join 
with me. Let's give our suffering communities a better policy for a 
brighter, healthier future.
  Mr. BARTON of Texas. Mr. Speaker, may I inquire as to the time 
remaining.
  The SPEAKER pro tempore. The gentleman from Texas has 4\1/2\ minutes 
remaining, and the gentleman from New Jersey has 7 minutes remaining.
  Mr. BARTON of Texas. Mr. Speaker, I yield myself 2 minutes.
  Mr. Speaker, I want to put into the Record a letter dated September 
19, 2006, from the County of Los Angeles signed by Reginald Todd, the 
Chief Legislative Representative for that county to Congresswoman Bono, 
where he states strong support of the current bill before us, and I 
want to read one sentence from this letter:
  ``The county understands that absent this legislation the Health 
Resources and Services Administration will count only HIV cases for 
States with mature named-based HIV reporting systems in allocating 
Federal fiscal year 2007 Ryan White CARE Act funds. This would have a 
devastating fiscal impact on California and the County of Los Angeles. 
The proposed CARE Act reauthorization effectively addresses many of the 
concerns raised by the County's Board of Supervisors in its August 30, 
2006, letter to you.''

                                            County of Los Angeles,


                            Washington, DC Legislative Office,

                               Washington, DC, September 19, 2006.
     Hon. Mary Bono,
     House of Representatives,
     Washington, DC.
       Dear Representative Bono: I am writing to communicate Los 
     Angeles County's support for the Ryan White HIV/AIDS 
     Treatment Modernization Act of 2006, which is due to be 
     marked up by the House Energy and Commerce Committee on 
     September 20, 2006.
       This Ryan White CARE Act reauthorization legislation would 
     allow states, such as California, which have converted or are 
     converting to a names-based HIV reporting system to use the 
     data collected through their code-based HIV reporting system. 
     As you know, this is extremely important for California and 
     Los Angeles County, which is the nation's second most HIV/
     AIDS impacted local jurisdiction. The Centers for Disease 
     Control and Prevention (CDC) currently does not count 
     California's HIV cases, as it does not consider the State's 
     name-based HIV reporting system to be mature. While hard work 
     lies ahead for California to fully implement its names-based 
     HIV reporting system, we are confident that this provision in 
     the legislation will adequately protect existing systems of 
     care for its residents who live with HIV and AIDS.
       The County understands that, absent this legislation, the 
     Health Resources and Services Administration (HRSA) will 
     count only HIV cases for states with mature name-based HIV 
     reporting systems in allocating Federal Fiscal Year 2007 Ryan 
     White CARE Act funds. This would have a devastating fiscal 
     impact on California and the County. The proposed CARE Act 
     reauthorization legislation effectively addresses many of the 
     concerns raised by the County's Board of Supervisors in its 
     August 30, 2006 letter to you. To further strengthen this 
     legislation, the County encourages you to support efforts to 
     extend the hold harmless provision for a total of 4 years, 
     and a provision that counts HIV cases in states working 
     toward mature HIV surveillance systems in periods when a hold 
     harmless provision is not in effect.
       Thank you for your assistance to the County on this 
     important issue.
           Sincerely,
                                                 Reginald N. Todd,
                                 Chief Legislative Representative.

  What we have before us, Mr. Speaker, is a classic case of a formula 
funding fight. Those States and those cities that were the epicenter of 
the AIDS epidemic 10 to 15 years ago benefit greatly from the current 
formula. However, the AIDS/HIV epidemic is moving. It is actually, 
luckily, thankfully, declining in some of the areas where it began; 
but, unfortunately, it is growing in other areas where it wasn't 
prevalent 10 or 15 years ago.
  The proposed legislation reallocates the funds based on HIV cases and 
AIDS cases. The old formula only counts AIDS cases. The old formula 
only counts what is called a named-base case. The new formula would 
allow for, in addition to named-based cases, also what are called code-
based cases, where individuals still have to be counted, but they are 
not collectively sent to HHS.
  Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
California (Ms. Waters).
  Ms. WATERS. Mr. Speaker, I thank the gentleman from New Jersey for 
the time.
  Mr. Speaker, I came to this floor really intending to support this 
bill. But, you know, I am not going to do it. I am not going to support 
this bill. It is not worth the paper it is written on.
  Here we are fighting with each other, people from New York and 
California and places fighting with people from the South because we 
have a piece of legislation that is pitting us against each other 
instead of funding what needs to be funded with HIV and AIDS.
  Over 1 million people in the United States have HIV/AIDS. African 
Americans are only 13 percent of the population, but we account for a 
half of all the new AIDS cases. African American women represent 71 
percent of the new AIDS cases among women, and African American 
teenagers represent 66 percent of the new AIDS cases among teenagers.
  The Congressional Black Caucus has been struggling and working, and I 
have been working on this for 15 years. We are spending $2 billion a 
week in Iraq. We only need $1 billion more to fund all of these 
programs adequately. What are we doing? Let's not play with this. Don't 
accept this. Don't pit yourself against your friends and your 
colleagues. Tear it up. It is not worth the paper it is written on. 
Vote ``no'' on this bill. Throw it out and let's start all over again 
next year.
  I am with my friends from New York. I support the South. But let's 
not be scrambling over pennies. People are dying. And don't tell me we 
don't have the resources to deal with it. Even if you didn't spend $2 
billion a week in Afghanistan, in Iraq, we would be able to fund this 
adequately.
  Somebody does not care that Americans are dying. Somebody doesn't 
give a darn that it is decimating black populations. Let's stop playing 
the game. Let's stop it today. Stop this bill. Don't think you're so 
desperate you have to vote for anything in order to get a little 
something. Throw it out. It's not worth it.
  Mr. BARTON of Texas. Mr. Speaker, I yield myself 30 seconds.
  I appreciate the gentlewoman's passion, but I just want to point out 
the facts. If we don't pass this bill today, the City of Los Angeles, 
in 3 days, is going to lose over $4 million, and the State is going to 
lose over $6 million. The State could lose up to 21 percent of its AIDS 
funds.

[[Page 20471]]

  Now, those are the facts.

                              {time}  1500

  Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to my colleague from 
New Jersey (Mr. Pascrell).
  Mr. PASCRELL. I rise today, Mr. Speaker, in strong opposition to the 
legislation before us. It reduces vital funding for States that are 
most heavily impacted.
  I absolutely disagree with the Chair. He is wrong when he says that 
this problem has shifted. The epidemic has expanded. It has not 
shifted. There are more areas that are involved, and we should be fair 
to all areas besides New York, California, Florida, Texas and New 
Jersey. I can't support that idea. If Ryan White resources are to 
follow the epidemic, they must continue to flow to all jurisdictions, 
and be increased.
  It is irresponsible to take an already inadequate pot of money and 
cover new areas with it, taking it away from the areas of need. If you 
don't understand what the need is in those five States that I 
recognize, I will give you the flat statistics: They are not 
diminishing in any sense of the imagination whatsoever. I don't know 
what facts you are looking at.
  Under the proposed bill in the House, Mr. Speaker, funding for New 
Jersey will be cut by $13 million. I looked at the numbers in New 
Jersey. I have worked on this problem for 15 years. I don't know where 
this gentleman is coming from when he says that the problem is less in 
those five States that I mentioned and increased in other areas. It 
just is not so. It is not true. Sixty thousand of these dollars will go 
directly to the two counties that I am involved in, a cut of 40 percent 
in the funding.
  I urge you to vote against this proposed legislation. It will hurt 
all EMA and the States most affected by the devastating effects of HIV.
  Mr. BARTON of Texas. Mr. Speaker, I reserve my time.
  Mr. PALLONE. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, I think if you have listened to those in opposition to 
this bill, you recognize that there is not a consensus. One of the 
things that disturbs me the most today is that this is on the 
suspension calendar. This does not belong on the suspension calendar 
because it is obviously a very controversial piece of legislation.
  Let me tell you, I heard my colleague from New Jersey (Mr. Pascrell). 
I went to one of the centers in my State in my district that treats 
AIDS and HIV patients, and I want to tell you, people are scared about 
this. They are very, very concerned that if this legislation passes in 
its current form that we are just not going to have the funding to deal 
with the AIDS and HIV cases in my State.
  Really, when you have a situation where so many people are worried 
about the impact this is going to have, and we have clear indication 
that this is not going to be enough money, this is simply not the way 
to go.
  I have no reason to believe if this bill goes to the other body that 
it is actually going to end up in something that goes to the 
President's desk. It is simply a mistake to deal with this on the 
suspension calendar with all the controversy that exists over it.
  Mr. Speaker, again, I want to stress again those of us who are in 
opposition to this bill, why we feel so strongly about it. The problem 
is that it is woefully underfunded. No one is suggesting that more 
money doesn't need to go to other parts of the country, that maybe the 
formula needs to be changed in some fashion. But the problem is there 
just isn't enough money to go around. So you have a situation where we 
are pitting one State against another or even different parts of the 
State of one State against other. It just isn't right.
  My colleagues on this side of the aisle have pointed out over and 
over again how we are spending money in Iraq, we are spending money on 
tax cuts. The problem here is the Republicans, those on the other side 
of the aisle, are not prioritizing funding where it should go. It 
should go to health care. It should go in this case to not only the 
AIDS patients but also those with HIV.
  The problem is we tried many times in committee to add through 
various amendments on our side of the aisle amendments that would 
increase the funding, hold harmless those States and those localities 
that need this funding under the current formula. Every time we tried 
to do that we were not successful because of the Republican leadership 
and the opposition, if you will, to the suggestions that we were 
making.
  I can't stress enough, there is not enough funding in this bill. We 
really should go back to day one. One of the amendments that I had was 
simply reauthorize the program the way it is for another year and hold 
us harmless for a year as we tried to find a solution that would be 
acceptable to everyone. That did not happen; and, instead, instead of 
having a normal debate and allowing amendments on the floor in the 
normal course of procedure, we stand here today with this bill on the 
suspension calendar.
  It shouldn't be here. The consensus doesn't exist. I urge my 
colleagues to vote against this legislation, and let's bring it back on 
an occasion when we can actually have a full debate and have 
amendments.
  Mr. Speaker, I yield back the balance of my time.
  Mr. BARTON of Texas. Mr. Speaker, I yield myself the balance of my 
time.
  Mr. Speaker, I will include for the Record a list of over 20 
organizations that have endorsed the bill, as well as a letter from the 
AIDS Institute dated September 28, 2006, signed by Dr. Gene Copello.
  Mr. Speaker, I want to read from the AIDS Institute endorsement 
letter that was dated September 28 by Dr. Gene Copello. I won't read 
the entire letter, but I want to read parts of it.
  It says, ``Dear Representative: The AIDS Institute,'' and this is a 
nonpartisan institute, ``urges you to vote `yes' today on the Ryan 
White HIV/AIDS Treatment Modernization Act, H.R. 6143.
  ``While no bill that is crafted through a series of compromises is 
perfect, the AIDS Institute strongly supports its immediate passage 
because it would better direct limited resources throughout the country 
in a more equitable fashion. Additionally, it contains a number of 
important reforms that seek to update the law to better reflect today's 
epidemic.
  ``If the bill is not passed this week, a number of States and the 
District of Columbia will lose funding, and the important reforms 
contained in the bill will not be allowed to be implemented for the 
coming year.''
  Mr. Speaker, the bill before us is the result of bipartisan, 
bicameral negotiations over a several year period. It is not perfect, 
but it is a better bill and better legislation than current law. It 
more equitably allocates the funds not just for AIDS patients but also 
for HIV patients.
  The States that lose in the new formula are guaranteed 95 percent of 
their current year funding for 3 years, 95 percent. And then, in the 
fourth or fifth year, they are allowed to petition through a 
supplemental fund to make up for these losses under the old baseline 
formula.
  This is a very fair compromise. It begins to treat all States on an 
equal footing; and it also, for the first time, begins to count HIV 
cases as well as AIDS cases. It deserves to be supported.
  Please vote ``yes.'' We do need a two-thirds vote to pass this, 
because it is on the suspension calendar. So we need more than a 
majority vote.
  Please vote ``yes'' on H.R. 6143.

     Organizations That Support the Ryan White HIV/AIDS Treatment 
                           Modernization Act

       AbsoluteCare Medical Center.
       ADAP Coalition.
       AIDS Action Coalition; Huntsville, AL.
       AIDS Alabama, Inc.
       AIDS Healthcare Foundation.
       AIDS Outreach of East Alabama Medical Center.
       Alaska Native Tribal Health Consortium.
       American Academy of HIV Medicine.
       American Dietetic Association.
       Am I My Brother's Keeper, Inc.
       Brother 2 Brother.
       Carepoint Adult, Child and Family.
       Catholic Charities Diocese of Fort Worth.
       First Ladies Summit.
       Harabee Empowerment Center.

[[Page 20472]]

       HIV Medicine Association.
       Latino Coalition.
       League of United Latin American Citizens (LULAC).
       Log Cabin Republicans.
       Lowcountry Infectious Diseases.
       Montgomery AIDS Outreach.
       National Black Chamber of Commerce.
       National Coalition of Pastors Spouses.
       National Minority Health Month.
       New Black Leadership Coalition.
       President's Advisory Council on HIV/AIDS.
       Rep. Linda Upmeyer (Iowa State Rep, District 12).
       South Alabama Cares.
       Southern AIDS Coalition.
                                  ____



                                           The Aids Institute,

                                               September 28, 2006.
     Re: Vote ``yes'' on Ryan White HIV/AIDS Treatment 
         Modernization Act.
       Dear Representative: The AIDS Institute urges YOU to vote 
     ``yes'' today on the Ryan White HIV/AIDS Treatment 
     Modernization Act (H.R. 6143). This important bill would 
     reauthorize the Ryan White CARE Act for the next five years. 
     Ryan White CARE Act programs provide lifesaving medical care, 
     drug treatment, and support services to over 535,000 low-
     income people living with HIV/AIDS throughout the nation. The 
     bill is the result of three long years of work and has been 
     carefully crafted in an unprecedented bi-partisan, bicameral 
     fashion.
       While no bill that is crafted through a series of 
     compromises is perfect, The AIDS Institute strongly supports 
     its immediate passage because it would better direct limited 
     resources throughout the country in a more equitable fashion. 
     Additionally, it contains a number of important reforms that 
     seek to update the law to better reflect today's epidemic.
       The bill prioritizes medical core services, including 
     medications; takes into account HIV case counts, in addition 
     to AIDS cases; and addresses such issues as co-morbidities, 
     unspent funds, accountability, and coordination of services. 
     While at the same time, the existing title structure and the 
     AIDS service infrastructure together with the social service 
     component of AIDS care and treatment remain.
       If the bill is not passed this week, a number of states and 
     the District of Columbia will lose funding, and the important 
     reforms contained in the bill will not be allowed to be 
     implemented for this coming year.
       This reauthorization process has been long and divisive for 
     all those involved. Unfortunately, it has pitted HIV/AIDS 
     patients from one part of the country against another. 
     Congress has to do what is best for the entire nation; just 
     not one state or region.
       The AIDS Institute urges you to vote ``yes'' on H.R. 6143.
       We thank you for your interest in this legislation, and 
     look forward to working with you to adequately fund Ryan 
     White CARE Act programs to meet the growing domestic need for 
     HIV/AIDS care and treatment. The AIDS Institute is extremely 
     disappointed the bill provides absolutely no increase next 
     year for the nation's AIDS Drug Assistance Programs (ADAPs). 
     We hope you will join us in seeking new additional money for 
     ADAP in FY07 as part of the Labor, HHS Appropriations bill.
       Should you have any questions or comments, please feel free 
     to contact me or Carl Schmid, Director Federal Affairs for 
     The AIDS Institute at (202) 462-3042 or 
     [email protected].
           Sincerely,
                                              Dr. A. Gene Copello,
                           Executive Director, The AIDS Institute.

  Ms. LEE. Mr. Speaker, I must reluctantly rise in opposition to H.R. 
6143.
  As the Co-chair of the Congressional Black Caucus Global AIDS 
Taskforce, I have consistently fought for more funding for our HIV/AIDS 
programs.
  Along with my colleagues in the CBC, we have helped lead efforts to 
raise awareness about HIV/AIDS in the African American community, and 
last year the House passed my resolution supporting Black HIV/AIDS 
Awareness Day.
  I have also tried to do my part to encourage wider testing for HIV, 
introducing several resolutions on the subject, and just yesterday by 
getting tested with my colleagues in the CBC.
  With my colleagues I have also worked to dramatically scale up U.S. 
foreign assistance on HIV/AIDS, provide the framework for the creation 
of the Global Fund, and focus assistance on orphans vulnerable to this 
disease.
  Unfortunately today I must stand against this bill because it 
significantly cuts HIV/AIDS funding in my district in Alameda County. 
In its current form, this bill will force the consolidation and closure 
of AIDS service organizations who are on the front lines in fighting 
this disease.
  I do believe there are some strengths to this bill. In particular the 
inclusion of the Minority AIDS Initiative--an initiative created 
through the leadership of my colleague Maxine Waters, the CBC, and 
President Clinton--should be applauded.
  But without changes to the current formulas, or increased 
appropriations to fund these programs, I cannot support this bill in 
its current form.
  Mr. LANTOS. Mr. Speaker, I rise in reluctant opposition to H.R. 6143, 
the Ryan White HIV/AIDS Treatment Modernization Act of 2006. I fear 
that this bill due to be reauthorized last year is now in danger of 
being rushed through to a vote just before a recess before an election.
  The bill, in its current form, does not adequately address the 
challenge of HIV/AIDS. Because tax cuts for the wealthiest Americans 
have contributed to extraordinary deficits, we are forced to pinch 
pennies when it comes to saving the lives of millions of Americans. 
Rather than provide needed increases for the Ryan White program, this 
bill reduces funding in larger metropolitan areas and redistributes 
those funds to rural and suburban areas faced with an increase in the 
number of HIV/AIDS patients.
  I am very concerned that all of those in need receive the necessary 
and appropriate treatment whether they live in urban, suburban, or 
rural communities. I firmly believe that the localities facing this 
increasing challenge should get the funds they need to care for their 
citizens. However, that should not come at the cost of taking away from 
cities like San Francisco, which has the highest per capita prevalence 
of people living with AIDS, and other cities such as Los Angeles, 
Chicago or New York. Saving our neighbors and loved ones from this 
epidemic should not come from a policy of robbing Peter to pay Paul.
  The Ryan White Act and all of those afflicted by HIV/AIDS needs our 
attention and our support for additional funds. Shortchanging this 
program insults its namesake, it insults the millions who have died 
from AIDS, it insults those who are currently living with it day in and 
day out, and it insults their families. There are millions of Americans 
who rely on this program to receive the services they so desperately 
need to live. I recognize that they are not just from San Francisco or 
New York, but they are also from Dubuque and Omaha, Charleston and 
Boise. I do not question the need for services and care. Geography 
should not determine whether you live or die from AIDS and that is why 
we should do more than simply shift money around.
  Mr. Speaker, I had hoped that we would be able to succeed in passing 
legislation that would help benefit all the victims of this illness. 
Instead, a bill may pass today that does not accomplish this goal. 
Rather it will help some and hurt others, especially I fear in the San 
Francisco Bay area. I urge my colleagues to take the needed time and 
bring us a bill we can all support wholeheartedly knowing that it will 
benefit all Americans with HIV/AIDS.
  Mr. NADLER. Mr. Speaker, I rise today in reluctant opposition to H.R. 
6143, the Ryan White HIV/AIDS Treatment Modernization Act of 2006. The 
Ryan White Comprehensive AIDS Resources Emergency (CARE) Act is the 
centerpiece of the federal government's response to the HIV and AIDS 
epidemic. H.R. 6143 woefully under-funds the HIV/AIDS resources the 
CARE Act provides; this bill is a deeply flawed shadow of what it could 
and should be.
  The Chairman has argued here today that the epicenter of the AIDS 
epidemic has shifted, and that the number of AIDS cases is on the wane. 
Therefore, he says, fewer resources are needed to fight the disease, 
and those funds can be spread around. I don't know where he gets his 
figures, Mr. Speaker. The Chairman is flatly wrong.
  The fact is that New York State has the most HIV cases and the most 
AIDS cases of any other state in the nation--almost 17 percent of HIV/
AIDS cases nationwide. More than half of people living with HIV in the 
United States reside in five states--New York, Florida, Texas, 
California, and New Jersey. The fact is that New York City has the 
oldest, largest, and most complex HIV/AIDS epidemic in the United 
States. New York City accounts for one of every six reported AIDS cases 
in the United States, and each year reports more AIDS cases than Los 
Angeles, San Francisco, Miami, and Washington, D.C. combined. And the 
fact is that the number of people who so desperately need the services 
in this bill has been and continues growing.
  But the funding has not. The programs the CARE Act covers have been 
level funded for years, despite increases in healthcare costs and 
inflation. And this bill unfortunately continues that trend. Under the 
flawed funding formula in this bill, three of the highest prevalence 
states in the nation--New York, Florida, and New Jersey--will lose 
significant funding. The City of New York predicts a $17.8 million loss 
in the first year alone, and more losses in each of the remaining 4 
years of the reauthorization; New York State anticipates a loss of $118 
million over the life of this bill.
  This will be unspeakably detrimental to the state's ability to care 
for the HIV/AIDS population. The reductions in funding will require

[[Page 20473]]

cost containment measures, including deep cuts in covered drugs and 
services. In the first year alone, this will translate to the 
elimination of nutritional, housing, mental health, and transportation 
services, as well as increased out-of-pocket costs for participants. 
This will also lead to a major reduction and/or removal of entire 
classes of drugs from the state's pharmaceutical formularies.
  We have a choice. We can go back to the table and negotiate a 
compromise. My friend from New Jersey, Representative Pallone, has 
introduced legislation (H.R. 6191) that would temporarily reauthorize 
the program for one year to allow Congress to continue working on a 
bill that would not unfairly reduce funds for any state. Additionally, 
H.R. 6191 would increase authorized appropriation levels for all titles 
of the CARE Act so we can get the services and treatment to people who 
need it while we craft a bill that works. This is the bill we should be 
voting on today.
  Mr. Speaker, my district has been on the frontline of the fight of 
this epidemic for over 20 years. I know a good approach when I see one, 
and the bill we are debating on the floor today isn't it. I urge a 
``no'' vote on H.R. 6143.
  Mr. McGOVERN. Mr. Speaker, it's hard to believe, but it's been 25 
years since the first AIDS case was reported in the United States. 
Growing from a cluster of cases in Los Angeles in 1981, this disease 
spread throughout every segment of our society--no one was left 
untouched, and we were all forced to watch helplessly as AIDS 
transformed into a world-wide pandemic. In all, there have been 1.6 
million cases of HIV infection in the United States including over 
26,000 in Massachusetts.
  Thanks to research and medical advancements, we began to make great 
strides in HIV treatment. By 1987, the first antiviral drug was 
approved by the Food and Drug Administration (FDA), and 3 years later, 
in 1990, Congress passed the Ryan White CARE Act, which helped to 
improve the quality and availability of care for persons with HIV/AIDS. 
Gradually, with adequate care and treatment, those infected with HIV 
began to live longer, healthier lives.
  Today, there are over 1 million people living with HIV/AIDS in the 
United States, the highest number in the history of this disease. But, 
with these improvements has come a greater need for the health care 
services and drug treatment provided by the CARE Act.
  Each year, 40,000 people are infected with HIV in the United States. 
But rather than increasing funding for these programs, Congress has 
flat funded the CARE Act for a number of years. And unfortunately, the 
bill that this House is considering today, H.R. 6143, which 
reauthorizes the Ryan White CARE Act, once again fails to provide the 
necessary funds to meet the needs of this growing population. Instead, 
it shifts funds around--robbing Peter to pay Paul--while placing an 
even greater strain on the program's limited resources. As a result, 
vital medical and supportive services stand to be severely underfunded 
without any consideration for the human lives at risk.
  A number of amendments were offered in Committee to increase funding 
for Title I, the Emergency Relief Grant Program, and Title II, the Care 
Grant Program. But, unfortunately, they were defeated by a largely 
party-line vote.
  And, today, rather than allowing these and other amendments to be 
brought before the full House for consideration, this Republican-
controlled Congress has closed off the process, providing us with only 
a mere up or down vote on this bill.
  For these reasons, I oppose H.R. 6143, and I urge my colleagues to 
join me in voting no.
  Mr. DINGELL. Mr. Speaker, I support H.R. 6143, the Ryan White HIV/
AIDS Treatment Modernization Act of 2006, but I also support providing 
significantly more funding for it. Since 1990, the Ryan White funding 
has been an integral part of our domestic response to the HIV/AIDS 
epidemic, helping metropolitan areas, States, and territories pay for 
essential healthcare services and medications for people living with 
and affected by HIV/AIDS.
  This is another program hurt by the majority's budget priorities. For 
every millionaire that gets a large tax cut, there are many people with 
HIV/AIDS not getting the help they need. And this underfunding means 
that the reforms in this bill hurt some States and cities that have 
borne the brunt of this crisis.
  Nonetheless, the bill before us has many improvements, and is worthy 
of support at this point even though authorization levels are too low. 
This bill recognizes the changing demographics of the HIV/AIDS epidemic 
in our Nation. It expands access, improves quality, and provides 
additional services to help target healthcare services and other 
support services to communities throughout our Nation that need them 
most.
  The policy of this bill may be adequate, but it is only a paper 
promise without sufficient funding. As this bill goes to conference, 
the majority will have one more chance to recognize the human cost of 
their budget priorities and properly fund this program.
  Ms. PELOSI. Mr. Speaker, 19 years ago, I came to Congress to fight 
AIDS, a disease that has taken nearly 18,000 lives in my city of San 
Francisco alone.
  We have lost friends, family, and loved ones, but we have not lost 
our will to fight this terrible disease. This year, we mark the 25th 
anniversary of the first diagnosis of AIDS--a stark reminder that this 
epidemic is still among us, and that our work is not done.
  Yet as we grieve for those we have lost, we are filled with hope as 
we see the strength of those who are fighting and living full lives 
with HIV and AIDS. This would not be possible without the help of the 
Federal Government through initiatives such as the Ryan White CARE Act. 
The act has been instrumental in our fight to defeat AIDS. It has 
greatly improved the quality and availability of health care services 
for people living with and affected by HIV and AIDS. I was proud to be 
a part of the creation of the Ryan White CARE Act.
  Unfortunately, I must rise in opposition to this reauthorization.
  There are a number of good provisions in this bill, including the 
recognition of emerging communities and the use of actual living AIDS 
counts rather than estimated living AIDS cases. That change will 
benefit many communities, including my constituents in San Francisco.
  However, when it comes to meeting the needs of people living with 
AIDS, our mantra should be the same as the physicians who care for all 
patients: first, do no harm. The primary problem with this legislation 
is that it fails to provide adequate funding for the treatment of HIV/
AIDS patients.
  Had this Administration and the Republican-controlled Congress made a 
priority of funding the Ryan White program over the last several years, 
I would be standing here in strong support of this bill. But they have 
not, and I cannot support this bill.
  Yet funding in this bill simply won't be able to meet the current 
demand for HIV/AIDS care in the United States. Under this 
reauthorization, San Francisco, with the highest per capita caseload of 
people living with AIDS in the country, stands to lose almost $30 
million over the next 5 years.
  That is a far cry from the bipartisan consensus we were able to 
achieve on this issue between 1993 and 2001. During that time, 
funding--adjusted for both inflation and caseload growth--under the 
Ryan CARE Act increased by 70 percent.
  Since 2001, funding has declined by 35 percent.
  The problem is not that one part of the country gets too much money 
and some other parts of the country are left behind. Instead, people 
suffering from this disease--and those caring for them--are being 
forced to compete for pieces of an ever-shrinking pie.
  If funding for this Act had simply kept pace with the number of 
people with AIDS and inflation, my city and all other cities and States 
would be getting increases in funding instead of grappling with how 
they can stretch--and where they will have to sacrifice--in meeting the 
growing demand for services.
  In fact, the impact of the cuts will be compounded, because in San 
Francisco, these funds form the basis for matching funds from the city.
  Due in no small part to this Federal, State and local investment, 
more people are living with HIV and AIDS now than dying from it. That 
is remarkable.
  As the epicenter of the epidemic, San Francisco has experienced 
terrible loss of life--but from that loss, my city has created a 
standard of care that has been a model for the Nation.
  But our problem has not gone away. There are more people living with 
AIDS in the San Francisco's area than at any point in the epidemic's 
history.
  This legislation has far-reaching implications for the stability of 
HIV/AIDS funding in our State and cities. The programs funded by the 
Ryan White CARE Act have literally been life-savers for people who live 
with HIV/AIDS.
  It has provided critical support to the cities that have been the 
center of the epidemic, and to States that have been funding critical 
drug and support programs to treat the disease. This cut in funding to 
San Francisco means a loss in services for patients receiving primary 
medical care, a lack of access to counseling, support, outreach 
services, transitional and emergency housing and emergency payments for 
health care costs.
  Where do these people go? What do we tell them when their ability to 
receive support to fight HIV/AIDS is cut off?

[[Page 20474]]

  In prior reauthorizations of the Ryan White CARE Act, the changes 
that have been made were made at the margins in order to deal with 
emerging problems and developments; these changes did not, however, 
disrupt an initiative that was working.
  Unlike those past reauthorizations, this bill would have a drastic 
destabilizing effect on many of the hardest-hit areas of the country, 
including California.
  A basic goal of this reauthorization must be to ensure that the 
actions we take do not destabilize systems already in place. 
Unfortunately, the bill fails to meet this goal and jeopardizes the 
critical funding of areas throughout the country, in general, and the 
State and cities of California in particular.
  In addition, the bill prematurely incorporates HIV reporting into the 
allocation formula, eliminates the hold harmless provision just when 
San Francisco and California need it the most, and allows the 
Administration to devise and implement a whole new funding formula 
without Congressional approval.
  It is for these reasons, I must oppose this bill. And I will submit 
the entirety of my statement for the record.
  The second major problem with this legislation is that there is 
simply no way to incorporate data on HIV cases into the funding formula 
on a consistent and comparable basis across jurisdictions. The 2000 
reauthorization of the Act included a requirement that HIV cases be 
incorporated into the funding distribution by no later than 2007. At 
that time, HIV reporting systems were in various stages of development 
across the country; although some states and cities had been reporting 
HIV cases by name since 1985, others had yet to implement an HIV-
reporting system at all. Given this landscape, the drafters understood 
the need to provide sufficient time to allow states and cities to begin 
collecting HIV cases. At the time, they believed seven years to be 
adequate for such a transition. As it turns out, it was not.
  As HIV reporting systems were developed, variations among these 
systems across jurisdictions emerged. Some areas reported HIV by the 
individual's name along with other identifying information. Others, 
like California, as a means of protecting the individual's 
confidentiality, opted not to report the person's name at all, and 
instead included only a unique code identifying the individual. The 
2000 reauthorization of the Ryan White Act did not specify which type 
of reporting system jurisdictions were required to use and nothing in 
the law prohibited this kind of variation. So long as the Secretary 
found that the data on HIV cases was ``sufficiently accurate and 
reliable,'' jurisdictions were free to report cases by name or by code. 
Thus, whether an area began collecting HIV by name or by code, they 
were on equally solid ground under the law.
  It was not until December 2005, that CDC first gave a clear 
indication that it would deem only cases reported by name to be 
``sufficiently accurate and reliable.'' In a letter to all code-based 
States, CDC set forth its strong recommendation that those States 
convert their systems to names-based--it did not, however, establish 
any sort of legal requirement. At that point, 13 States used some form 
of a code-based reporting system. In response to CDC's announcement, 
almost all code-based States began the process of converting. their HIV 
reporting systems to names-based systems.
  The reported bill would rely exclusively on names-based HIV and AIDS 
cases in making funding allocations starting in fiscal year 2011. In 
order to meet this deadline, and have all of their names-based HIV 
cases counted for funding purposes, code-based jurisdictions will be 
required to have completely converted to names-based systems in less 
than 3 years.
  For large and diverse code-based States with several very large 
cities, like California, this is simply not enough time to make this 
change. California essentially has to start from scratch. In its code-
based system, California currently has approximately 40,000 cases of 
HIV (non-AIDS). Under California law, these cases cannot simply be re-
tallied under the new names-based system. In order to incorporate these 
cases into the new system, the State must contact each of these 40,000 
individuals, and ask them to come in to a testing site to be re-tested. 
Some of these individuals are homeless. Some are drug-abusers. Many 
don't speak English. When personnel and resources are already strained, 
California will simply not be able to get all of these individuals 
entered into the names-based system in 3 years.
  The experience of other large code-based systems provides a sense of 
the difficulty of this task. New York, for example, converted to a 
names-based system in 2000 and is now considered by CDC to be mature. 
However, it is widely acknowledged that New York's current names-based 
HIV count severely undercounts the true burden of HIV in the State 
simply because it has not had enough time to find and report all of its 
HIV cases.
  I cannot support legislation that would disadvantage my State and 
city and take large amounts of dollars away simply because the data 
system is incomplete. The number of persons with HIV and with need for 
services remains. They should not lose needed services because of an 
unrealistic data requirement.
  Under the language of the proposal, it is also unclear on what basis 
the funds will be allocated. GAO and the State of California, both of 
which have modeled the bill, have quite different case counts for the 
same State and city. The proposed language says code-based numbers are 
used to determine funding allocations. HRSA numbers used by GAO in 
their estimates are not code-based numbers. Those numbers purport to 
show need--not any scientific way of counting cases and a method which 
surely varies from jurisdiction to jurisdiction depending on how much 
the grantee estimated. What assurance is there that the GAO numbers 
will be used to allocate funds in fiscal year 2007 and the out years? 
This does not pass the test of good government.
  Under the proposed language, the case count used in 2010 and 2011 in 
making the allocation to San Francisco will be substantially less than 
the actual number of HIV positive individuals who currently live in San 
Francisco. That simply is unfair and is not good policy.
  Because HIV reporting systems across the country remain in a state of 
flux, it is critical that this reauthorization protect against severe 
losses in funding when the bill requires that the funding be based on 
HIV cases. The most effective way to accomplish this protection is to 
incorporate a hold-harmless provision for the entire life of the bill. 
Unfortunately, the current bill protects a jurisdiction's funding for 
only the first 3 years. This is not enough.
  California faces the most drastic cuts at the very time the hold 
harmless under the bill comes to an end. By California's estimates, the 
State stands to lose nearly 25 percent of its total Ryan White Care Act 
funding during the 5th year of the bill alone. Our State simply cannot 
sustain these kinds of losses.
  In year 5, when transition to names-based reporting becomes 
mandatory, California (and all other jurisdictions moving to names-
based reporting) will lose substantially. The amount of loss is 
difficult to ascertain, because it will depend entirely upon how 
quickly California and other jurisdictions can transition to names-
based reporting.
  The elimination of the hold harmless will have a devastating impact 
on the provision of HIV/AIDS services in San Francisco. The hold 
harmless was adopted to protect the epicenters of this disease from 
experiencing drastic reductions in CARE funding from year to year that 
would disrupt the systems of care in place, and eliminating it now 
would cause this very consequence. As you may know, the city of San 
Francisco consistently has invested local funds into the fight against 
this disease and the care of those living with HIV/AIDS. San Francisco 
has been conscientiously preparing to absorb cuts as a result of the 
eventual loss of the hold harmless, but the more than one-third cut in 
funding proposed is punitive and will eliminate critical care for 
thousands of people living with HIV/AIDS.
  Finally, I cannot support the bill's inclusion of the so-called 
``severity of need index'' (SONI). The bill requires the Secretary to 
develop a SONI to measure the relative needs of individuals living with 
HIV/AIDS, but fails to specify the factors that should be incorporated 
into this index, leaving it entirely up to the Secretary. Further, the 
bill then permits the Secretary to completely discard the current 
funding formula and distribute funding on the basis of this SONI 
beginning as early as FY 2011 without Congressional action. This is 
unacceptable. Congress--not the Administration--should be solely 
responsible for making such a drastic shift in the way funds are 
distributed under the Act.
  Mr. GENE GREEN of Texas. I rise in support of this legislation to 
reauthorize the Ryan White CARE Act. Initially enacted in 1990, the 
Ryan White CARE Act provides critical medical treatment to individuals 
living with HIV and AIDS. The Ryan White program is essentially a payer 
of last resort and specifically targets uninsured and medically 
underserved individuals living with HIV and AIDS.
  In my community in Harris County, our Hospital District utilizes more 
than $26 million each year to coordinate essential health care and 
support services for more than 21,000 individuals in our community 
living with HIV and AIDS. The importance of this program cannot be 
overestimated; without CARE Act funds, many Americans living with HIV 
and AIDS would have no other source for treatment.
  This reauthorization bill includes an important change in the 
criteria used to formulate

[[Page 20475]]

funding under the Ryan White program. Thus far, funding was determined 
based on a grantee's estimated number of living AIDS cases, with a 
jurisdiction's number of HIV cases not included in funding 
determinations.
  As the HIV/AIDS epidemic has shifted geographically, our funding 
formulas must change to meet increased need for care in certain areas. 
Southern States and rural areas are seeing higher numbers of 
individuals with HIV, for whom treatment is necessary. I wholeheartedly 
support the use of HIV counts in CARE Act funding formulas to provide 
these areas with the support they need to develop appropriate systems 
of care. However, it is important that the funding formula recognize 
that urban areas--particularly those in New York--continue to be the 
epicenter of the AIDS epidemic. Unfortunately, this bill does not 
provide the necessary assurances that communities with a high 
prevalence of HIV/AIDS will have the resources to maintain their 
systems of care.
  In this kind of formula fight, the battle lines are drawn 
geographically rather than ideologically. I appreciate the work of 
Chairman Barton, Ranking Member Dingell, and their staffs, who worked 
tirelessly for more than 6 months to develop a bi-partisan, consensus 
bill that sought to address great need in every area of this country. 
Nevertheless, in this type of bill there are always winners and losers. 
This bill contains more winners than losers, and my State of Texas 
comes out a winner, relatively speaking. For that reason, I am happy to 
support this legislation and encourage my colleagues to do the same.
  Mr. CROWLEY. Mr. Speaker, I rise in opposition to the Ryan White HIV/
AIDS Treatment Modernization Act of 2006.
  Today as we debate the Ryan White HIV/AIDS Treatment Modernization 
Act of 2006 we must take into account one fact. The fact is that New 
York is the epicenter of the HIV/AIDS epidemic, and while New York has 
the highest prevalence of HIV/AIDS in the country, they have made the 
most progress in battling this disease.
  Now, in a normal situation, New York would be rewarded with more 
funds to battle this epidemic, and be set as an example for the rest of 
the country, however under this bill they would not be. In fact, the 
opposite would occur. Under the current proposal, New York City would 
lose a whopping $17 million the first year, and New York State would 
lose an estimated total of $78 million over the course of the 4 years 
of the reauthorization.
  My district, in New York has one of the highest prevalence of HIV/
AIDS in all of New York City. This bill would take precious funds away 
from individuals in my districts, as well as New York State, 
California, New Jersey, and Florida and other states that are on the 
front line of this fight.
  To add insult to injury, the Republican Congress refuses to give this 
bill the due diligence it deserves. Instead they are debating this bill 
under Suspension of the rules, with no opportunity for Members to offer 
amendments and a short debate schedule.
  This is unacceptable for New York, this is unacceptable for New 
Jersey, this is unacceptable for Florida, and most importantly this is 
unacceptable for the millions of people who will have to suffer as a 
result.
  I urge my colleagues to vote ``no'' on this legislation. Instead 
let's continue to negotiate so New York, New Jersey, Florida and other 
states that stand to lose millions can be spared.
  Mr. SOUDER. Mr. Speaker, as the nation's largest AIDS-specific care 
program, the Ryan White CARE Act plays a critical role in providing 
HIV/AIDS treatment and support equally to all U.S. citizens needing 
such medical care. Ryan White, as many of you know, was a fellow 
Hoosier and a heroic young man and this program that so many depend 
upon to stay health and alive is a great tribute to him.
  Currently, the federal government is funding wasteful and unnecessary 
programs that would otherwise be held in check if this reauthorization 
had already been law. This bill would require that 75 percent of CARE 
Act funds be spent on primary medical care and medication. This is 
important because in the past, funds were misspent on unnecessary and 
dubious programs while thousands living with HIV were on waiting lists 
for AIDS medications.
  Let me give a recent example of government waste that would have been 
better spent treating those with HIV but without access to treatment.
  According to the Department of Health and Human Services, $405,000 in 
federal funds was provided this month to the National Minority AIDS 
Council for its annual U.S. Conference on AIDS. Held at a beachside 
resort in Hollywood, Florida, the conference featured a ``sizzling'' 
fashion show, beach party, and ``Latin Fiesta.'' Indirect costs are not 
yet available from HHS regarding the cost of sending 67 employees from 
the Centers for Disease Control and Prevention, 5 employees from the 
National Institutes of Health (NIH), and one NIH contractor.
  While such spending strikes one as strange, the examples don't end 
there. The New York Times reported that New York was paying for dog 
walking and candle-lit dinners with AIDS funds, while other areas of 
the country do not even have sufficient funds to pay for medications 
for those living with HIV. Hot lunches, haircuts, art classes, and even 
tickets to Broadway shows were financed by federal funding.
  Indeed, although the federal government spends over $21 billion on 
HIV/AIDS annually, up to a staggering 59 percent of Americans with HIV 
are not in regular care. This misallocation of funds is great cause for 
concern and should motivate Members of Congress to respond by 
supporting the reauthorization of the Ryan White CARE Act. By doing so, 
greater oversight in funding would be provided.
  The reauthorization of this act would prioritize medical care and 
treatment over less essential services and programs. I ask my 
colleagues to support this reauthorization.
  Ms. ESHOO. Mr. Speaker, when Congress passed the Ryan White CARE Act 
in 1990, we sent hope to millions of Americans who were living under a 
death sentence that came with a diagnosis of HIV or AIDS. In large part 
because of Ryan White, outcomes have dramatically improved.
  This bill fails to uphold the hopeful tradition of the original 
legislation because it creates a system of winner and losers in the 
allocation of federal resources. This major reauthorization of our 
federal HIV/AIDS policy is also being considered under suspension of 
the rules, prohibiting Members from offering amendments to address the 
serious deficiencies in the bill.
  Last week, I offered an amendment with several of my colleagues from 
the California, New York and New Jersey delegations to increase the 
overall authorization levels in the bill which would helps address the 
needs of communities more recently affected by the epidemic. Our 
amendment also extended the hold harmless provisions of the bill by two 
years to ensure that the historic epicenters of the disease do not 
experience precipitous declines in funding levels from year to year. 
Our amendment was defeated by a single vote.
  Today we can't offer that amendment or any other. Instead, we're left 
with a ``take it or leave it'' proposed that doesn't adequately respond 
to the real needs of people suffering from HIV and AIDS.
  Congress has responsibility to address the imminent crisis facing 
emerging communities, but we can't abandon the infrastructure of care 
already in place. By eliminating the hold harmless provision after 
three years in order to free up funding for emerging communities, some 
localities will experience sharp funding declines.
  The bill also doesn't allow sufficient time for states to transit HIV 
code-based reporting systems to the more efficient names-based system. 
Although California is making enormous strides to comply, Governor 
Schwarzenegger reports that the state will likely miss the 2009 
deadline, sustaining a loss of up to $50 million, or 23 percent, of its 
total funding in FY2011. Such a loss has the potential to derail the 
entire state's HIV/AIDS care system.
  Given my serious concerns about the ability of this bill to preserve 
current infrastructure of care while extending assistance to areas of 
the country newly affected by the HIV/AIDS epidemic, and with no 
opportunity to address these concerns with amendments, I reluctantly 
oppose this bill.
  Mrs. LOWEY. Mr. Speaker, I rise in reluctant opposition to the Ryan 
White Treatment Modernization Act.
  Like many of my colleagues in the New York delegation, I strongly 
support the Ryan White CARE Act and have supported its reauthorization 
in the past. These programs provide lifesaving medical care, drug 
treatment, and support services to over 535,000 low-income people 
living with HIV/AIDS throughout the nation.
  Westchester County, in my congressional district has the highest 
number of persons living with HIV or AIDS of any New York State county 
outside of New York City. The services provided under the Ryan White 
CARE Act literally mean the difference between life and death for my 
constituents living with this devastating disease.
  Unfortunately, the bill before us today will jeopardize these 
services for my constituents and countless other Americans in states 
that are at the epicenter of this crisis.
  Under this bill, New York State stands to lose more than $78 million 
over four years.
  Despite what some say, the AIDS epidemic has not shifted--it has 
expanded. It simply

[[Page 20476]]

makes no sense to pit regions of the country against each other by 
providing vitally needed services to one region at the expense of 
another.
  My colleagues, rushing a bill through the House that will negatively 
impact the lives of so many individuals living with HIV and AIDS makes 
no sense. I am a cosponsor of legislation, H.R. 6191, that would 
temporarily reauthorize the program for one year to allow Congress to 
continue to negotiate a compromise that would not unfairly result in 
drastically reduced funds for any state.
  I urge the House leadership to immediately consider H.R. 6191 and 
urge my colleagues to vote against the bill before us.
  Mrs. MALONEY. Mr. Speaker, I rise in opposition to H.R. 6143, Ryan 
White HIV/AIDS Treatment Modernization Act of 2006. While I fully 
support this program and believe we must do everything we can to assist 
those living with and affected by HIV/AIDS, H.R. 6143 will destabilize 
established systems of care and will be devastating for New York. While 
the HIV/AIDS epidemic has expanded, more than \1/2\ of all people 
living with AIDS in the United States reside in just 5 States: New 
York, California, Florida, Texas, and New Jersey. Under this bill's 
flawed formula, 3 of the highest prevalence States, including New York, 
will lose significant funding. New York City predicts a possible $17.8 
million loss in the first year of implementation of this bill and 
potential increasing losses in each of the remaining 4 years of the 
reauthorization. In total, New York State expects losses of up to $78 
million in the first 4 years of reauthorization. Of course, New York is 
not opposed to other regions of the country receiving more funding, but 
it should not be at the expense of New York. Instead, we should 
increase the authorization of appropriations for the program so that we 
do not pit states against each other.
  I urge my colleagues to vote against this bill so that the Committee 
can find a compromise that will not result in reduced funds for any one 
State.
  The SPEAKER pro tempore (Mr. Terry). The question is on the motion 
offered by the gentleman from Texas (Mr. Barton) that the House suspend 
the rules and pass the bill, H.R. 6143, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds of 
those present have voted in the affirmative.
  Mr. PALLONE. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this question will 
be postponed.

                          ____________________